Zahf Shaikh, DO1, Sachin N. Mysore, 2, Sabrienne Alice Olanio, BS3, Michelle Menna, MD4, Sourav Dutta, MS5, Zamir Brelvi, MD, PhD6 1Hackensack Meridian Palisades Medical Center, Randolph, NJ; 2EndoLogic, Edison, NJ; 3EndoLogic, Bloomfield, NJ; 4Endologic LLC, Montville, NJ; 5Endologic LLC, Franklin Lakes, NJ; 6Hackensack Meridian Mountainside, Endologic LLC, Montville, NJ
Introduction: Given the subjective nature of Irritable Bowel Syndrome (IBS), excess testing is often ordered. Prior studies have postulated IBS is due to overgrowth of intestinal bacteria and subsequent alteration in intestinal gas composition. Our pilot investigation with Bowel Sound Analysis (BSA) reveals correlation between bowel sound activity and IBS symptom severity. This study further explores BSA and its proposed correlation with Lactulose Breath Test (LBT) and IBS symptom severity. Point of Care analysis of bowel sounds is a potential diagnostic tool that is non-invasive and may provide objective data for evaluating the severity of IBS.
Methods: This is a case-control study including IBS patients who met Rome IV criteria. Gastrointestinal Symptom Rating Scale IBS (GSRS-IBS) was used to quantify severity of symptoms. A score of >35 was considered an IBS flare-up. Bowel sounds were collected for 45 seconds from 3 points around the umbilicus with an electronic stethoscope. Audio files were analyzed based on proprietary computer software modeled after previous IBS patients. The model uses scores < 5 as normal, 5-10 as mildly abnormal, and >10 as abnormal. Patients were given a TrioSmart LBT provided by Gemelli Biotech to complete post-appointment.
Results: A total of 63 patients completed the GSRS and BSA. A scatterplot of GSRS vs BSA scores demonstrated an R2 of 0.591 with ANOVA calculated p-value < 0.0001. A total of 37 patients completed the LBT. Using the established thresholds of symptom severity, a chi-square test between 3 variables yielded a p-value < 0.005 with the tree map exhibiting the categories each patient fell into. We note, as seen in the proximity matrix table, that the BSA had a greater overlap with symptom severity when compared to the LBT. This suggests the BSA captures audio data pertinent to the severity of IBS symptoms beyond bacterial dysbiosis.
Discussion: Point of Care BSA may serve as a promising objective assessment for IBS. The time-efficient and point-of-care application of BSA may allow it to serve as a screening procedure to help evaluate and treat patients with IBS. A large sample cohort study of the BSA between pre and post-treatment patients would need to be done to establish a better understanding. If validated, the BSA could provide clinicians with an objective marker to ascertain IBS presentation, response to therapy, as well as couple with the LBT to assess specific abnormal intestinal gas levels that may subsequently guide treatment plans.
Figure: Figure 1.A. Scatterplot of IBS symptom Score over the Bowel Sound Score: The above graph details a best of fit model to predict IBS symptom severity over the score received on the BSA. The data fits the model to an R^2 of 0.591 with an ANOVA of regression showing a p-value <0.0001
Figure 1.B. Proportional chart represents 3-way correlation between 3 given tests: The Treemap bins each patient into a category depending on the results of all 3 tests. The probabilities of each positive test within the 37 patient sample were used to create an expected value table which was then used to perform a chi-square test of independence. The test of association showed a p-value of <0.005.
GSRS
LBT
BSA
GSRS
1
0.708
0.784
LBT
0.708
1
0.708
BSA
0.784
0.708
1
Table: Proximity Matrix (Percent agreement) between Gastrointestinal Symptom Rating Scale IBS (GSRS), Lactulose Breath Test (LBT), and Bowel Sound Analysis (BSA)
Disclosures:
Zahf Shaikh indicated no relevant financial relationships.
Sachin Mysore indicated no relevant financial relationships.
Sabrienne Alice Olanio indicated no relevant financial relationships.
Michelle Menna indicated no relevant financial relationships.
Sourav Dutta indicated no relevant financial relationships.
Zamir Brelvi indicated no relevant financial relationships.
Zahf Shaikh, DO1, Sachin N. Mysore, 2, Sabrienne Alice Olanio, BS3, Michelle Menna, MD4, Sourav Dutta, MS5, Zamir Brelvi, MD, PhD6. D0261 - Point of Care Bowel Sound Analysis Shows a 3-Way Correlation Between IBS Symptom Severity and Lactulose Breath Testing, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
