Developing ‘smart toilet’ uses artificial intelligence (AI) to analyze stool for consistency and the presence of blood – and early evidence suggests it’s more accurate than patient self-report , a study reveals.
Remote, automated, real-time analysis and reporting increases the likelihood that doctors will detect gastrointestinal (GI) problems sooner, investigators report.
In a proof-of-concept study, smart toilets were 85% accurate in classifying stool consistency as loose, normal, or constipated. The results were presented at the Digestive Disease Week (DDW) 2021 virtual meeting.
âThis study highlights a very innovative and practical tool that could have major implications for patients and clinicians,â said Andrea Shin, MD, who was not affiliated with the research. Medscape Medical News.
“The shape or consistency of the stool and the signs of bleeding are some of the most important pieces of clinical history when it comes to gastrointestinal or intestinal symptoms,” added Shin, assistant professor of medicine in the department. of Gastroenterology and Hepatology from Indiana University School of Medicine at Indianapolis.
The researchers tested their AI algorithm on 3,328 images. They rated photos from the Internet and some were submitted anonymously by study participants.
Two gastroenterologists also evaluated a subset of 552 images. Physicians showed “satisfactory agreement” on inter-rater reliability (the extent to which two or more “raters” [eg, observers, examiners] okay), investigators noted.
The smart toilets were also 76% accurate for macroscopic blood detection.
âIt’s objective and more specific,â said study author Sonia Grego, PhD. Medscape Medical News. Unlike asking patients to keep a stool diary or remember the frequency and consistency of their stools over time, “the system does it for you,” she added.
âOur technology – by automating image acquisition – saves you having to follow your model for weeks or months,â added Grego, founding director of Duke Smart Toilet Lab at Duke University in Durham, North Carolina.
The information provided by patients “can have a big impact on decision-making,” Shin said. “For example, if I talk to a person who is in pain irritable bowel syndrome (IBS) I often ask them how loose or watery and hard or shaped their stools are, as this information gives me clues to the underlying issues that may be causing their symptoms. “
Shin agreed that it can be difficult for people to know what is important to report to their doctor. âThis tool has the potential to ease patient burden and facilitate communication between patient and clinician. It’s a great example of how technology can be leveraged to improve care.
Working behind the scenes
Working with gastroenterologist Deborah Anne Fisher, MD, associate professor of medicine at Duke, Grego and his colleagues designed a prototype that positions the image analyzer in the pipes behind the toilet. The analysis is therefore carried out after rinsing.
âWe are toilet and toilet technology experts,â said Grego. “We’ve learned that people really don’t like to see anything weird around the toilet bowl.”
The smart toilet system is designed for multiple users in a residential or commercial setting. The technology could be used in hospitals or long-term care facilities, for example. A fingerprint reader on the flushing mechanism tracks each individual user.
Grego elicits a whole range of reactions when she tells people she is developing smart toilet technology.
“Friends and family don’t care about the concept of a smart toilet,” she said, “so every possible joke that has been made about poo, we know that.”
In fact, researchers also collect the jokes they hear. “We are very systematic.”
In contrast, gastroenterologists who learn about the developing technology are more enthusiastic, Grego said. âThere is such a need to eliminate the uncertainty of patient recall about the frequency and appearance of bowel movements.
“We are looking to grow through collaboration with additional GI physicians. We want to develop a more advanced prototype and do further validation studies,” said Grego.
Digital health tool
There is an aversion in patients to manipulate the stool “or even talk about it,” Grego said. Colleagues tell him that people are more willing to provide a blood sample, which requires a needle, than a stool sample.
“But there is a lot of health data [in the stool]”, She added.” We believe that this will allow for a lot of research as well as the collection of data on consumers. “
For example, Grego envisions pharmaceutical companies using the technology to detect or monitor any changes in stool or bowel health based on a treatment being developed in clinical trials.
Additionally, the technology could allow health-conscious consumers to track their own gut health. âThis technology will be a whole new entry in the digital health toolbox,â said Grego.
While not included in the research presented at this year’s DDW, the developers plan to add sampling capability. Biochemical analysis of stool samples could provide “metabolically relevant information,” including stool biomarkers and microbiome composition.
âWe have demonstrated that in the lab. It will be part of the technology when it is developed into a product,â said Grego.
This proof of concept study “is the first step on a path that we are aggressively pursuing,” said Grego. She estimated that it would take around 12 to 18 months to develop a prototype for use with patients. “We hope to switch to a product soon after.”
âI can’t wait to see future iterations of this tool,â Shin said. “It could play a role in the monitoring of major gastrointestinal illnesses and disorders, including IBS and inflammatory bowel disease, or even for the detection of “alarm symptoms” which should not be ignored. “
âI might even see it playing a role in preventive health in the future,â Shin added.
The technology was licensed to the spin-off company Coprata to further develop the product.
âWe hope to have an impact on people’s health very soon,â said Grego.
duke university funded the study. Grego holds a management position at Coprata. Shin did not disclose any relevant financial relationship.
Digestive Diseases Week 2021 Virtual Meeting: Summary Sa651. Presented on May 22, 2021.
Damian McNamara is a journalist working in Miami. It covers a wide range of medical specialties, including infectious diseases, gastroenterology and intensive care. Follow Damian on Twitter: @MedReporter. For more news, follow Medscape on Facebook, Twitter, Instagram, Youtube, and LinkedIn