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Just published in ‘Gut’, results from a pilot study on Barrett’s oesophagus using the Aeonose

Detection of Barrett’s oesophagus through exhaled breath using an electronic nose device

Yonne Peters, Ruud W M Schrauwen, Adriaan C Tan, Sanne K Bogers, Bart de Jong, Peter D Siersema


Timely detection of oesophageal adenocarcinoma (OAC) and even more so its precursor Barrett’s oesophagus (BO) could contribute to decrease OAC incidence and mortality. An accurate, minimally-invasive screening method for BO for widespread use is currently not available. In a proof-of-principle study in 402 patients, we developed and cross-validated a BO prediction model using volatile organic compounds (VOCs) analysis with an electronic nose device. This electronic nose was able to distinguish between patients with and without BO with good diagnostic accuracy (sensitivity 91% specificity 74%) and seemed to be independent of proton pump inhibitor use, the presence of hiatal hernia, and reflux. This technique may enable an efficient, well-tolerated, and sensitive and specific screening method to select high-risk individuals to undergo upper endoscopy.

Multicenter study Colon rectal cancer and advanced adenomas

In December 2019, results of a multicenter clinical study on detection of colorectal cancer and advanced adenomas using exhaled-breath analysis was published in ‘Alimentary Pharmacology & Therapeutics’:

Title: ‘Volatile organic compounds in breath can serve as a non‐invasive diagnostic biomarker for the detection of advanced adenomas and colorectal cancer’

Authors: Kelly van Keulen, Maud Jansen, Ruud Schrauwen, Jeroen Kolkman, and Peter Siersema

The paper can be viewed online here (Open Access)

Subsidie toegekend

Subsidieaanvraag gehonoreerd voor project:

Van Ademanalyse-Module naar ZorgOplossing (AMZO)

De Aeonose is een elektronische neus, die het mogelijk maakt om diverse ziektebeelden te detecteren door middel van ademanalyse. Deze analysemethode is snel en niet-invasief en daarmee ook patiëntvriendelijk.

Binnen de medische sector bestaat behoefte aan een patiëntvriendelijke en betrouwbare testmethode voor de Helicobacter pylori bacterie. Ruim 15% van de Nederlandse bevolking is met deze bacterie besmet. Uit een pilotstudie is de geschiktheid van de Aeonose hiervoor gebleken.

Binnen dit project zullen technologieontwikkelaars (eNose BV, Auxzenze BV, NTG), zorginstellingen (Radboudumc, Isala, Bernhoven) en medisch laboratorium Medlon samenwerken om:

  • De Aeonose klinisch te valideren voor de Helicobacter pylori bacterie,
  • Een systeem-oplossing uit te werken voor bediening, lokale connectiviteit en data-uitwisseling met zorg-IT systemen.

Na succesvolle afronding van het AMZO-project kunnen we overgaan tot uitrol naar Nederlandse diagnostische centra en ziekenhuizen. Dat is tevens een opmaat naar toepassing in andere landen, waardoor dit project op termijn een grote bijdrage aan de volksgezondheid kan leveren, zowel in Nederland als daarbuiten.

Aeonose breath analysis on TB screening South Africa

This year, the Union World Conference on Lung Health was held in Hyderabad, India. At the TBScience pre-conference, an official event entirely devoted to basic and translational tuberculosis (TB) research, study results were presented on the Aeonose exhaled-breath tests in Cape Town.


It shows the Aeonose may be useful as a triage test for tuberculosis in HIV-infected and uninfected persons as it meets the FIND/WHO minimum Target Product Profile (TPP) for a rule-out TB test.



An exhaled-breath screening test for the detection of active pulmonary tuberculosis in patients presenting to primary health care clinics in Cape Town, South Africa.

Aliasgar Esmail, Keertan Dheda, Muhammed Dhansay


Introduction: GeneXpert Ultra is unsuitable for community-based mass screening and in up to one-third of patients an adequate sputum sample is unavailable. By contrast, the analysis of exhaled breath obtained by the Aeonose-TB device has the potential to provide an easy, onsite, rapid, and non-invasive diagnosis of tuberculosis. Thus, it may serve as a useful community-based triage tool (a major unmet need in the TB field).


Methods: We enrolled 1,143 participants (31% HIV- infected) with suspected TB (243 microbiologically-con- firmed TB, 130 probable TB, and 770 non-TB) from primary care clinics in Cape Town, South Africa. Sputum GeneXpert MTB/RIF and/ or culture served as the reference standard. Volatile organic compounds in exhaled-breath were detected using an electronic nose containing 3 metal-oxide sensors (AeonoseTM, Zutphen, The Netherlands). Data were analysed by machine learning using artificial neural networks (ANN) in a ‘leave-10%-out’ cross-validation training set (n=756; 189 TB and 567 non-TB) and the findings ratified in a test set (n=257).


Results: In the training set the sensitivity, specificity, PPV, NPV of Aeonose-TB (95% CI) was 81% (74-86) and 60% (55-64), 40% (35-45), and 90% (87-93), respectively. However, in HIV uninfected patients, using a ANN- derived rule-in threshold, performance characteristics were 59% (50-69), 91% (87-93), 68% (58-77), and 87% (83-90), respectively. In the same group, using an ANN- derived rule-out threshold, the performance characteristics were 90% (83-95), 59% (54-65), 43% (36-49) and 95% (91-97), respectively. Results in the validation set, and in HIV-infected persons, showed comparable performance characteristics.


Conclusion: Aeonose-TB may be useful as a triage test for tuberculosis in HIV-infected and uninfected persons as it meets the FIND/WHO minimum Target Product Profile (TPP) for a rule-out TB test. However, it may also have utility to rule in TB in sputum scarce or smear-negative persons. Further studies are now required to clarify these findings.

Aeonose breath analysis on TB screening Peru

The Union World Conference on Lung Health 2019 was held in Hyderabad (India) from October 30 – November 2. Dr. Ruvandhi Nathavitharana (Harvard University) presented results on the Aeonose exhaled-breath TB-study in Lima, suggesting Aeonose may meet WHO triage test criteria to rule out TB (90% sensitivity, 70% specificity) in lower-risk patients admitted with cough or TB risk factors.

Improving lung cancer screening results

At the ERS Conference in Madrid (September 28 – October 2, 2019), Sharina Kort (MST, Enschede, the Netherlands) presented clinical study results on diagnosing lung cancer using the Aeonose:

  1. Improving lung cancer diagnosis from exhaled-breath analysis by adding clinical parameters to the artificial neural network (oral presentation)
  2. Combining exhaled-breath analysis data with clinical parameters to improve the diagnosis of lung cancer (poster presentation)

Combining the electronic nose data and easily-available clinical parameters, she obtained a sensitivity of 96% and a negative predictive value of 93%. Nice results!

Pancreas new diagnostics

Improved diagnostics for pancreatic diseases are badly needed. An electronic nose (AeoNose™) analysing exhaled breath was successfully used to distinguish between pancreas carcinoma, chronic pancreatitis (inflammation of the pancreas), and healthy controls: promising results from a multicenter pilot study in the Netherlands.

Pancreatic ductal adenocarcinoma and chronic pancreatitis may be diagnosed by exhaled-breath profiles: a multicenter pilot study

Presentations at DDW San Diego

At the Digestive Disease Week in San Diego, 4 posters were presented discussing ongoing clinical studies with the Aeonose for exhaled-breath analysis:

  • Colorectal cancer and advanced adenomas
  • Barrett’s esophagus (presented both by Radboud University (Nijmegen, the Netherlands) and Mayo Clinic (Rochester))
  • Fasting state

Mo1003 — 2019  AGA
Kelly v. Keulen1, Maud E. Jansen2, Ruud W. Schrauwen3, J.J. Kolkman2,4, Peter D. Siersema1


Sa1136 — 2019  AGA    Poster of Distinction 
Yonne Peters1, Ruud W. Schrauwen2, A.C. Tan3, Sanne Bogers2, Bart de Jong1, Peter D. Siersema1


Sa1153 — 2019  AGA   
Juan Reyes Genere1, Kavel Visrodia2, Liam Zakko3, Bryan Linn1, Magdalen A. Clemens1, James Allen1, Lori S. Lutzke1, Kenneth K. Wang1


Mo2053 — 2019  AGA   
Juan Reyes Genere1, Liam Zakko2, Kavel Visrodia3, Magdalen A. Clemens1, James Allen1, Bryan Linn1, Lori S. Lutzke1, Kenneth K. Wang1

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