The Medical Futurist | July 4, 2019

Gluten? Lactose? Stomach pain? Digestive troubles? Way too many people suffer from gastrointestinal issues, and much less are aware of the digital technologies that can come to their aid. Did you know that digestibles could successfully replace the dreaded colonoscopy? Or have you heard about microbiome testing? What about the swarm of health apps supporting dietary restrictions? We took a deep breath and jumped into the universe of digital technologies just to bring you as much information about the future of gastroenterology as possible. Will you jump after us?

IBS, colorectal cancer, and other animals

Referring to Gerald Durrell’s autobiographical work, gastroenterology is a universe that deals with a swarm of diseases related to the digestive system, including the intestines, liver, pancreas, or the biliary tree, although it is often only identified with colorectal cancer and irritable bowel syndrome (IBS) that are becoming more and more common nowadays. And perhaps also with one of the most unpleasant medical examinations ever – colonoscopy.

While a significant amount of people suffers from digestive problems, it is still considered a rather intimate, embarrassing, and/or minor medical issue, which might not even be shared with the family physician. If you believe that’s not true just think about whether you rather share your skiing injury with a complete stranger or that you have been experiencing constipation for the last week. A survey conducted among more than 2,000 U.S. adults in 2013 proves the point: 72 percent of the respondents said they have experienced at least one of the following gastrointestinal (GI) symptoms a few times a month or more: diarrhea, gas, bloating, stomach pain, frequent bowel movements, unexplained weight-loss, and non-specific GI discomfort. Surprisingly, a majority of the surveyed participants (74 percent) have lived with their symptoms for more than six months. Despite this, more than half (56 percent!) of those who have experienced such discomfort have not spoken with their primary care doctor because they do not believe their problems require physician attention.

As a consequence, statistics show that far more people are affected by digestive diseases, such as IBS, gastroesophageal reflux disease, ulcerative colitis (UC), or Crone’s disease (CD) and the like, than we assume and the later clinicians start the diagnostic and treatment process, the more serious issues might occur.

In the U.S., 60 to 70 million people are affected by all digestive issues, while more than 20 million Canadians suffer from such disorders every year. In Asia, trends show that due to the industrialization, changes in diet, improved sanitation, and the increased use of antibiotics, gastrointestinal diseases are on the rise. According to another report from 2018, the five most common digestive cancers – colorectal, gastric, pancreatic, liver, and oesophageal cancer – are responsible for over 590,000 cases each year in the European Union. If current population trends continue, the number of deaths from these cancers across the EU per year will increase by over 40 percent by 2035. That’s an alarming forecast, and we should do everything that we can to mitigate these bleak numbers.

Better digestive health comes with dietary considerations

Digestive troubles have a lot to do with the modern, urban lifestyle, plenty of stress, and inversely proportionally few quality time for eating. Although our digestive system should be taken seriously and with the utmost respect. It’s a fascinating biological achievement: for example, did you know that the stomach has the ability to stretch and hold up to 4 pounds of food at one time? Or have you been aware of the facts that the small intestine is about 22-23 feet long, and your body can move your food through the digestive system even while you are standing on your head? That’s because it is not connected to gravity but works with muscles.

No matter how considerately the digestive system is built, though, it seems that in many cases it cannot keep up with the heaps of stress and irregular diets that you can get out of the fast-moving world. Sooner or later your belly will send signals such as uncomfortable stomach troubles if you don’t pay attention to it. A healthy lifestyle with plenty of physical activity and a balanced diet could help keep your stomach issues on track and prevent the development of serious health issues. Thus, we looked around how digital health could help keep your digestive system healthy, and what could technologies do in case you already have to manage gastrointestinal conditions.

Don’t just guess what’s on your plate

In the future, dietary restrictions due to gastroenterological conditions could be managed easier with food scanners. Gluten? Lactose? Carbohydrates and fats? Currently, we have absolutely no idea what we are eating – not to speak about what we should.Food scanners promised they would be able to tell how many grams of sugar a piece of fruit contains, or what the alcohol percentage of a drink is. Canadian TellSpec announced its aim is to develop a handheld food scanner that can inform users about specific ingredients and macronutrients, but the market launch is unfortunately in delay. The Israeli company SCiOintroduced a technology similar to TellSpec’s but is designed to identify the molecular content of foods, medicines, and even plants. The company says that in milliseconds the ingredients and molecular make–up of the foodstuff will appear on the user’s smartphone. However, their promises have yet to be fulfilled, as the scanner that they introduced on the market does not exactly deliver what the demo did.

On the other hand, the Nima gluten-sensor can help patients with Celiac disease to eat out not having to think about the ingredients in their food all the time. The portable gadget was named one of Time Magazine’s 25 best inventions of 2015. It is a nicely designed tool able to tell you from a small food sample within two minutes whether the food on your plate contains gluten. It is very handy, as based on thousands of restaurant visits, the Nima community found that 1 out of 3 foods that are claimed to be gluten-free actually contains gluten.

The firm already applied its technology to detect another, potentially lethal food allergen, peanut. We tested both portable sensors (here and here), and we have to say: they work wonders. We firmly believe that the future will bring similar portable food sensors and scanners so that people with all kinds of dietary restrictions could have peace of mind while eating out.

Home sensors, health apps and a gut pill as a gastroenterologist

Nevertheless, food sensors and scanners are only a tiny fracture of the bigger picture. Digital health technologies could support the successful management of chronic gastrointestinal diseases, such as IBS from eating through physical activities to medical monitoring – through a combination of health apps, sensor-based technologies, and telemedicine. That’s not only beneficial but also necessary as experts say that most patients with these gastrointestinal conditions spend less than a few hours per year in face-to-face communication with their healthcare providers, and the remainder of the year is spent in “self-management.”

As disease management is a significant challenge, a swarm of health apps appeared to help patients with gastrointestinal troubles. For example, the Bathroom scout provides information about the nearest restroom facilities, which is extremely useful in embarrassing stomach situations. On another note, Lisa’s Diet helps log the details of ingested meals and find possible correlations between the food and the severity of accompanying symptoms. GI Monitor does something similar: keeps a real-time record of stomach troubles and helps find links among lifestyle, diet, and symptoms. And, for example, My Pain Diary keeps a record of the level of pain that the user experiences and strives to find environmental factors to pinpoint triggers.

Moreover, in the future, patients could use various home sensors to monitor their digestive system, and even discuss the findings with their doctor remotely. Atmo Biosciences, for example, developed a gas-sensing capsule, which can electronically report important data about the human gastrointestinal system by detecting gases in real-time from known locations within the gut. The results could be used for diagnosis, resulting in targeted treatment, and earlier relief of symptoms and reduced healthcare costs.

With microbiome for better diagnostics

In the future, not only food and home sensors could support patients in keeping dietary restrictions, but various methods could also help with the diagnostics of gastrointestinal conditions. In the last years, microbiome testing started to gain ground, and we believe that it is just the beginning.

Experts are saying that microbiome acts like an organ itself, and it’s central to the body’s operations. It is believed that people carry about three pounds of bacteria in their intestines. Everyone’s individual microbiome, which is the collection of genes within these microorganisms, is as unique as their fingerprint and comprised of hundreds of different types of bacteria. It affects aging, digestion, the immune system, cognitive functions – and even mood. A study from UCLA found that gut bacteria might influence mood and brain function. Moreover, another study published in Nature Communications found a clear link between gut microbiota and the triggering of the behavioral signs of stress. Thus, testing gut bacteria could help with diagnosing conditions as well as understanding our bodies much better.

There are already companies that offer microbiome testing: the very first start-up offering this service was Ubiome, but the number of companies focusing on the gut microbiome is on the rise. Viome, the Estonian Microbiome, or the California-based Thryve all offer such services. We tested the latter here. The company sequences microbiome and offers personalized recommendations based on the gut bacteria, such as personalized probiotics or which types of bacteria to increase in the body to become healthier. Although their predictive power is rather limited at the moment, with the advancement of DNA sequencing technologies, as well as the details of microbiome testing and its application in gastroenterology, in the future, such tests could facilitate more efficient diagnostics for gastrointestinal or liver diseases.

Digestibles and pillcams for less invasive colonoscopy

Another strand of innovation that could greatly help diagnostics in gastroenterology focuses on the nano. Who would believe that tiny robotic creatures might become the biggest fighters against conditions in the intestines? That’s what’s happening, though.

Researchers working in nanotechnology are experimenting with exceptionally micro-sized – smaller than a millimeter – robots that literally swim through your bodily fluids, and one possible way to apply them to the digestive system is the creation of (well, what a surprise in the name) digestibles“. These tiny pills or gadgets combined with a sensor could track digestion and the absorption of drugs after swallowing them and could send back valuable information to clinicians. The FDA approved the first digital pill with a digital ingestion tracking system in 2017.

In addition, our miniature helpers could even liberate us from the dreaded colonoscopy. To lessen the burden on the patients when it comes to the exam, innovators developed capsule endoscopy as an alternative screening method to the traditional, unpleasant and painful colonoscopy. The technology is already more than 20 years old, and the FDA approved the device for investigations of the small intestines in 2001.

As a result of the successful first studies, Medtronic developed the PillCam COLON system that features a small camera inside an ingestible capsule that provides a direct view of the colon and support for confident diagnosis. In the future, we expect classic colonoscopies to entirely disappear in favor of such pillcams. Imagine that the medical exam will go down like the following: the doctor asks you to swallow a tiny, pill-like camera. Afterward, you both follow on a large screen where the digestible cam moves in the meandrous intestine system. Better visibility, much less discomfort.

Virtual reality could lessen the pain

Brennan Spiegel and his research team at the Cedars-Sinai Medical Center have been experimenting with virtual reality (VR) for years, especially how it could mitigate chronic pain. For example, in their recent clinical trial, out of 100 people who self-reported persistent, daily pain, half had the chance to play a VR game called Bear Blast. The other half got to watch 2-D relaxation videos of lakes and babbling brooks. While they experienced a small bit of relief, the VR group reported feeling 25 percent less pain than when they started.

At a recent conference, Spiegel envisioned the application of the technology in functional diseases, such as IBS, in which there is already strong evidence of a mind-gut component to symptom flares. He said, “VR can help patients engage with their body differently, changing how they react to symptoms and leading to better coping mechanisms.”

In one example, Spiegel displayed a video of a woman experiencing severe pain due to liver ascites testifying to substantial pain relief after a VR experience that included images that took her far from her hospital room. He reported that gastrointestinal pain relief is so consistent with VR treatment that failure to respond prompts him to reevaluate patients for missed organic pathology. That means that in the future, we can expect VR treatment to become part of the gastroenterology toolkit when it comes to managing chronic pain.

As digestibles, home sensors, health apps, microbiome testing, or even advancements in virtual reality show, the future gastroenterology is moving more and more towards self-management, especially in the cases of chronic conditions. The treatment of gastrointestinal diseases, such as IBS, cannot and should not rely exclusively on the patient-doctor meetings, as that’s too rare and the patient needs constant advice, information, data, as well as continuous counseling to be able to keep up with dietary restrictions or build up a completely new lifestyle if necessary. Digital health technologies can and will help significantly to empower patients and support them on their successful journey towards disease management.

Original Article