IBS Can Be Diagnosed by Listening to Bowel Sounds

Maureen Salamon

June 07, 2018

WASHINGTON, DC — The diagnosis of irritable bowel syndrome (IBS) using bowel sounds recorded by a noninvasive device could eliminate the need for costly colonoscopy testing, a new study suggests.

"After seeing so many people with IBS over the years, I decided we needed something to stop everyone requiring all these expensive investigations," said Barry Marshall, MBBS, from University of Western Australia in Crawley.

"Even if we cut the number of colonoscopies by, say, 10%, it would be a cost savings of billions of dollars in the United States," Marshall told Medscape Medical News. "It's one of the great times in gastroenterology. We're developing new ways of looking at disease and using new technologies."

IBS affects about 11% of people worldwide, but the diagnosis typically involves colonoscopy to exclude cancer or other organic disease.

The artificial intelligence used in the proof-of-concept study, dubbed the "noisy guts project," was derived from a device similar to one that detects termites behind house walls.

Even if we cut the number of colonoscopies by, say, 10%, it would be a cost savings of billions of dollars in the United States.

"If it hears crunching noises inside the wood, it knows you have termites," said Marshall, who received, with collaborator Robin Warren, the 2005 Nobel Prize in Physiology or Medicine for discovering the role of Helicobacter pylori in gastritis and peptic ulcer disease.

"That got me thinking," he explained here at Digestive Disease Week 2018. "For hundreds of years, doctors have been listening to the stomach with a microphone — that's nothing new — but only for about 20 seconds."

But with this artificial intelligence device, "we could listen for several hours, and could actually listen in several places and do some provocative testing with meals," he said. "We could put all that information into an AI learning engine, and we might be able to say, 'this is IBS'."

Noisy Guts Project

Marshall and his colleagues developed a prototype belt that uses machine-learning techniques to identify patterns of sounds emanating from the abdomen.

The sounds of irritable bowel syndrome

 

During the first phase of the study, recordings from 31 IBS patients and 37 healthy participants were used to build an acoustic index model to differentiate IBS gut sounds from gut sounds unrelated to IBS.

Bowel sounds were recorded for 2 hours after participants had fasted and then for 40 minutes after a standardized meal. During this phase, the device yielded 90% sensitivity and 92% specificity for IBS diagnosis, according to a computerized leave-one-out cross-validation statistical method.

During the second phase of the study, independent testing on 15 IBS patients and 15 healthy participants yielded 87% sensitivity and 87% specificity for IBS diagnosis.

It is likely that gut motility is at the root of IBS. The "squishy noises" emitted by the intestines of people affected by IBS are "very, very soft and hard to hear, but a computer can filter them out," Marshall said.

"Also, you can tell which part of the bowel it's coming from — the colon, small bowel, or stomach," he reported. "We have four microphones in different quadrants of the abdomen. We're at the stage where we can say it's normal or not normal and compatible with IBS."

The technology now needs to be replicated and tested in many more patients, he added.

This is "interesting. Anything to reduce more invasive testing is great," said Ashton Harper, MBBS, head of medical affairs for Protexin in Somerset, United Kingdom.

"I've not come across this and wouldn't have thought it would be reliable because it's not ever been used before," Harper told Medscape Medical News.

"It's impressive that it can differentiate between IBS and normal patients," said Susan Lucak, MD, from Weill Cornell Medicine and Lenox Hill Hospital in New York City.

It would be great if the technology could be validated in other conditions, as well, she told Medscape Medical News.

Marshall is a coinventor of the technology and will profit if it goes to market. Harper and Lucak have disclosed no relevant financial relationships.

Digestive Disease Week (DDW) 2018: Abstract Tu2017. Presented June 5, 2018.

Follow Medscape Gastroenterology on Twitter @MedscapeGastro and Maureen Salamon @maureensalamon

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