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Intestinal metabolic bromhidrosis syndrome

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Intestinal metabolic bromhidrosis syndrome (IMBS) is a hypothetical disorder, that is characterized by bromhidrosis and halitosis symptoms that may be 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 claim to have chronic body odor and bad breath despite a completely normal or even higher hygienic standard. An alternative diagnosis if no odor can be confirmed by a reliable third party, patients may be experiencing Olfactory Reference Syndrome - a condition where they exhibit obsessive-compulsive type symptoms and a delusional belief over a non-existent or minor body odor.

Recent intestinal metabolic research

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

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:

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.

A complaint of multiple odors is a key indicator of Olfactory Reference Syndrome, alongside refuse-related odors.

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
  • Defects in SELENBP1 gene which leads to accumulation of methanethiol and a cabbage like body odor and halitosis

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. Elevated dimethylglycine levels in urine samples are known to also correlate with fish odor symptoms

References

  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. McNiven, Vanda; Mamane, Sarah; Zai, Gwyneth; So, Joyce (March 2019). "The Nose Knows… or Does it? Olfactory Reference Syndrome in Patients Presenting for Assessment of Unusual Body Odor". The Journal of Nervous and Mental Disease. 207 (3): 145–151. doi:10.1097/NMD.0000000000000933. ISSN 1539-736X. PMID 30720598.
  4. 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.
  5. 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.
  6. 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.
  7. "DIMETHYLGLYCINURIA (DMGDHD)". www.metagene.de. Retrieved 2021-02-22.

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