Intestinal metabolic bromhidrosis syndrome

Intestinal metabolic bromhidrosis syndrome (IMBS) is a disorder^{[citation needed]}, that is characterized by bromhidrosis and halitosis symptoms that are caused by odorous intestinal metabolites passing through the intestinal wall and by the liver to be excreted by skin glands and the lung gas exchange.

Patients with those symptoms show chronic body odor and bad breath despite a completely normal or even higher hygienic standard.

Recent intestinal metabolic research

Bromhidrosis is regularly viewed as a classical dermatological disorder,^[1] but recent medical research is more and more putting focus on the intestinal metabolism as a source of bromhidrosis symptoms.^[2]

Types of chronic body or halitosis odors

IMBS as a syndrome is wrapping several specific subsets of body and/or halitosis odors to be present as a symptom:

Fecal like body odor (indole, skatole)
Sweat like body odor (carboxylates)
Sweaty feat like body odor (isovalerate)
Vomit like body odor (butyrate)
Urine like body odor (ammonia)
Rotten eggs like body odor (sulfides)
Rotten fish like body odor (trimethylamine)
Rotten meat like body odor (putrescine)
Cabbage like body odor (methanethiol)

In patients a single but also any combination of different body odor or halitosis smells might be present. Additionally those symptoms can vary based on different dietary choices over time.

Underlying diseases

IMBS as a syndrome can be caused by various (mostly rare) diseases.

At the moment following diseases are already defined and known to cause Bromhidrosis symptoms:

Trimethylaminuria
Dimethyglycineuria^[3]
Defects in SELENBP1 gene which leads to accumulation of methanethiol and a cabbage like body odor and halitosis^[4]

As intestinal research progresses, it is expected that further diseases emerge that are able to explain the occurrence of all the observed types of body odor.and halitosis types and their corresponding intestinal metabolites.

Correlation with irritable bowel syndrome (IBS)

Newer studies on the field of IBS research showed e.g. elevated dimethylglycine levels in urine samples of patient subgroups.^[5] Elevated dimethylglycine levels in urine samples are known to also correlate with fish odor symptoms^[6]

References

^ Sun, Pengfei; Wang, Yanjin; Bi, Minglei; Chen, Zhenyu (2019-04-14). "The Treatment of Axillary Odor: A Network Meta-Analysis". Medical Science Monitor. 25: 2735–2744. doi:10.12659/MSM.913932. ISSN 1234-1010. PMC 6478402. PMID 30982056.
^ Mogilnicka, Izabella; Bogucki, Pawel; Ufnal, Marcin (2020-04-20). "Microbiota and Malodor—Etiology and Management". International Journal of Molecular Sciences. 21 (8): 2886. doi:10.3390/ijms21082886. ISSN 1422-0067. PMC 7215946. PMID 32326126.
^ Moolenaar, Sytske H; Poggi-Bach, Jo; Engelke, Udo FH; Corstiaensen, Jacqueline MB; Heerschap, Arend; de Jong, Jan GN; Binzak, Barbara A; Vockley, Jerry; Wevers, Ron A (1999-04-01). "Defect in Dimethylglycine Dehydrogenase, a New Inborn Error of Metabolism: NMR Spectroscopy Study". Clinical Chemistry. 45 (4): 459–464. doi:10.1093/clinchem/45.4.459. ISSN 0009-9147. PMID 10102904.
^ Pol, Arjan; Renkema, G. Herma; Tangerman, Albert; Winkel, Edwin G.; Engelke, Udo F.; de Brouwer, Arjan P. M.; Lloyd, Kent C.; Araiza, Renee S.; van den Heuvel, Lambert; Omran, Heymut; Olbrich, Heike (January 2018). "Mutations in SELENBP1, encoding a novel human methanethiol oxidase, cause extraoral halitosis". Nature Genetics. 50 (1): 120–129. doi:10.1038/s41588-017-0006-7. ISSN 1546-1718. PMC 5742538. PMID 29255262.
^ Yamamoto, Mai; Pinto-Sanchez, Maria Ines; Bercik, Premysl; Britz-McKibbin, Philip (2019-05-20). "Metabolomics reveals elevated urinary excretion of collagen degradation and epithelial cell turnover products in irritable bowel syndrome patients". Metabolomics. 15 (6): 82. doi:10.1007/s11306-019-1543-0. ISSN 1573-3890. PMID 31111238. S2CID 160013135.
^ "DIMETHYLGLYCINURIA (DMGDHD)". www.metagene.de. Retrieved 2021-02-22.

External links

Official IMBS patient organization website

[1] Sun, Pengfei; Wang, Yanjin; Bi, Minglei; Chen, Zhenyu (2019-04-14). "The Treatment of Axillary Odor: A Network Meta-Analysis". Medical Science Monitor. 25: 2735–2744. doi:10.12659/MSM.913932. ISSN 1234-1010. PMC 6478402. PMID 30982056.

[2] Mogilnicka, Izabella; Bogucki, Pawel; Ufnal, Marcin (2020-04-20). "Microbiota and Malodor—Etiology and Management". International Journal of Molecular Sciences. 21 (8): 2886. doi:10.3390/ijms21082886. ISSN 1422-0067. PMC 7215946. PMID 32326126.

[3] Moolenaar, Sytske H; Poggi-Bach, Jo; Engelke, Udo FH; Corstiaensen, Jacqueline MB; Heerschap, Arend; de Jong, Jan GN; Binzak, Barbara A; Vockley, Jerry; Wevers, Ron A (1999-04-01). "Defect in Dimethylglycine Dehydrogenase, a New Inborn Error of Metabolism: NMR Spectroscopy Study". Clinical Chemistry. 45 (4): 459–464. doi:10.1093/clinchem/45.4.459. ISSN 0009-9147. PMID 10102904.

[4] Pol, Arjan; Renkema, G. Herma; Tangerman, Albert; Winkel, Edwin G.; Engelke, Udo F.; de Brouwer, Arjan P. M.; Lloyd, Kent C.; Araiza, Renee S.; van den Heuvel, Lambert; Omran, Heymut; Olbrich, Heike (January 2018). "Mutations in SELENBP1, encoding a novel human methanethiol oxidase, cause extraoral halitosis". Nature Genetics. 50 (1): 120–129. doi:10.1038/s41588-017-0006-7. ISSN 1546-1718. PMC 5742538. PMID 29255262.

[5] Yamamoto, Mai; Pinto-Sanchez, Maria Ines; Bercik, Premysl; Britz-McKibbin, Philip (2019-05-20). "Metabolomics reveals elevated urinary excretion of collagen degradation and epithelial cell turnover products in irritable bowel syndrome patients". Metabolomics. 15 (6): 82. doi:10.1007/s11306-019-1543-0. ISSN 1573-3890. PMID 31111238. S2CID 160013135.

[6] "DIMETHYLGLYCINURIA (DMGDHD)". www.metagene.de. Retrieved 2021-02-22.

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