When it comes to poop, a picture is worth a thousand words. And soon, thanks to a new device that records everything about our stool before it gets flushed away forever, doctors will be able to use these pics for faster and more accurate diagnoses of gastrointestinal conditions.
The technology, presented at Digestive Disease Week by a researcher from Duke University, turns normal toilets into smart thrones that use artificial intelligence to photograph and analyze bowel movements mere moments after they occur. The devices, which can be installed within the plumbing of existing toilets, provide a wealth of information doctors can use to diagnose and treat gastrointestinal issues such as Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS).
“Typically, gastroenterologists have to rely on patient self-reported information about their stool to help determine the cause of their gastrointestinal health issues, which can be very unreliable,” said Deborah Fisher, one of the study’s lead authors and an associate professor of medicine at Duke University in Durham, N.C. “Patients often can’t remember what their stool looks like or how often they have a bowel movement, which is part of the standard monitoring process. The smart toilet technology will allow us to gather the long-term information needed to make a more accurate and timely diagnosis of chronic gastrointestinal problems.”
Irritable Bowel Syndrome is a disorder of the large intestine related to how food travels through the digestive system and how the brain interprets the signals it receives from the area. Symptoms include bloating, cramping, abdominal pain and diarrhea and constipation or both. Canada has one of the highest rates of IBS in the world, according to the Canadian Digestive Health Foundation, at 18 per cent compared to 11 per cent globally. More than 70 per cent of patients report that their symptoms get in the way of everyday life, with almost half missing some work or school as a result. Between 40 and 60 per cent of IBS patients also experience psychological symptoms, including anxiety and depression.
Inflammatory Bowel Disease is an umbrella term used to encompass chronic inflammation of the digestive tract. Conditions, including ulcerative colitis and Crohn’s disease, are experienced by roughly one per cent of Canadians.
The new devices, once installed, snap a photo of passing poops shortly after the toilet is flushed. The information amassed over time will give gastroenterologists a more complete picture of the size and shape of a patient’s stool and the presence of blood — factors that influence diagnosis and treatment.
The team developed the artificial intelligence aspect of the tool by analyzing 3,328 unique stool images provided by participants or found online. Gastroenterologists reviewed and grouped the images in accordance with the Bristol Stool Scale and employed a deep learning algorithm that had an 85.1 per cent success rate at identifying stool form and 76.3 per cent accuracy with gross blood detection.
“We are optimistic about patient willingness to use this technology because it’s something that can be installed in their toilet’s pipes and doesn’t require the patient to do anything other than flush,” said Sonia Grego, one of the study’s lead researchers and the founding director of the Duke Smart Toilet Lab. “An IBD flare-up could be diagnosed using the smart toilet and the patient’s response to treatment could be monitored with the technology.
“This could be especially useful for patients who live in long-term care facilities who may not be able to report their conditions and could help improve initial diagnosis of acute conditions.”
The smart toilet, which is not yet available to the public, is currently being fine-tuned to detect specific biochemical markers to provide highly specific data to gastroenterologists.
Separate research presented during Digestive Disease Week revealed that IBS patients experienced an unexpected improvement in symptoms during COVID-19 lockdowns.
“One of our main hypotheses was that these patients were going to be worse because of pressure and stress due to COVID-19,” said Juan Pablo Stefanolo, one of the study’s lead authors and a physician with the Neurogastroenterology and Motility section, Hospital de Clínicas José de San Martín, in Buenos Aires University, Argentina.
“We think the results have something to do with people staying at home. They were not exposed to outside stress, and at home they were able to avoid food triggers.”
Of the 129 IBS patients involved in the study in Argentina — a country with one of the longest lockdowns in the world — the number experiencing severe symptoms dropped from 65 to 39. The mean Irritability Bowel Syndrome Severity Scale for the group fell significantly and symptoms of pain, distention, stool consistency, anxiety, somatization, fibromyalgia and chronic fatigue symptoms all improved. “Our results reinforce the concept that IBS, or functional gastrointestinal disorders, have a connection to psychosocial factors, as well as food and other factors,” Stefanolo said. “The gut-brain axis has a lot of facets.”
Dave Yasvinski is a writer with Healthing.ca