Understanding 6 trends shaping healthcare through one specialty: gastroenterology

If you throw a pebble today, it's likely to land on an article that talks about how artificial intelligence and its brother machine learning are changing healthcare.

Yes, I get it broadly. But I was curious to explore how exactly healthcare's trends are shaping any one medical specialty. I chose gastroenterology (GI) because I'm most familiar with the space. And here's what I found.

Trend #1: Manipulating bacteria in your stomach (Microbiome)

We are still a long way from fully understanding the microbiome (the microorganisms in our body). However, fecal transplants (it's what you think - restoring bacteria by infusing stool of a healthy donor) have shown promising results. Especially for inflammatory conditions such as C. Diff Colitis and autoimmune conditions such as inflammatory bowel disease.

The human microbiome industry is expected to be worth $3.2B by 2024. The company, Commense develops approaches to "guide the priming, seeding, and maintaining of the microbiome in infants and children". Openbiome is a non-profit stoolbank promoting safe access to fecal transplants (by the way, they offer $40/session).

Just as with genetic editing, the future may offer the ability programmatically manipulate a patient's microbiome to result in better health.

Refer: Is The Future Of Microbiome Research Already Here?

Trend #2: Genetic editing for stomach cancer (Genomics)

In 2018, a Chinese scientist claimed that he produced the world’s first CRISPR babies (gene-edited ones). There are several companies (e.g. Myriad Genetics) working to tackle specific conditions such as beta-thelassemia (blood disorder).

GI isn't too far. Research suggests that CRISPR-Cas9 technology can be used to genetically modify organoids. To understand GI diseases such as pancreatic cancer, gastric cancer better.

Refer: Modeling Human Digestive Diseases With CRISPR-Cas9–Modified Organoids

Trend #3: Computer vision to detect polyps (AI)

Detecting adenomas (benign tumors) is the holy grail of colonoscopies that GI doctors routinely perform. With the help of AI, doctors could potential detect adenomas with greater accuracy.

As an alternative to traditional colonoscopy, video capsule enteroscopy offers videos via a capsule that traverses through a patient's digestive tract. 50,000 images are captured over a period of 8-72 hours. AI can 'view' these images and videos and highlight polyps (small growths) that the human eye can miss.

Refer: Development and validation of a deep-learning algorithm for the detection of polyps during colonoscopy (Nature)

Trend #4: Fitbit for the abdomen (Wearables)

Monitoring electrical activity of the stomach has been in the works. The stomach sensor syncs with an app to send signals of gastrointestinal events (think bowel moments).

Startup GI Logic developed a biosensor to listen to the abdomen and classify the signals via Abstats. The Wearable device suggests a new way to monitor patients to before/after GI procedures.

Refer: Tummy Tech Tracks Electrical Activity for Signs of Indigestion (IEEE Spectrum)

Trend #5: Minimally invasive GI procedures (Robotics)

Endoscopic procedures such as Peroral Endoscopic Myotomy (called POEM, to treat achalasia), Natural orifice transluminal endoscopic surgery (called NOTES, to remove gallbladder) are on the rise. They offer benefits of faster recovery, less pain, potential for scarless procedures and so on.

A variety of devices, instruments, scopes, imaging techniques are making these advanced endoscopic procedures possible.

Refer: Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review

Trend #6: Customizing accessories to remove difficult lesions (3D printing)

Not limiting itself to printing models of damaged parts, 3D printing aims to print tissues of organs themselves.

Closer to the present, gastroenterologists are experimenting with 3D printing custom endoscopic caps (accessories that attach to a scope) to remove difficult-to-target lesions in procedures such as endoscopic mucosal resection (EMR). EMR is yet another procedure to remove cancerous lesions from the stomach.

Refer: Mo1520 New Technique for GI Endoscopy Using 3D Printing (GIE Gastrointestinal Endoscopy)

Connecting the dots: So what?

The science part of healthcare has always progressed rapidly. Making it easier for patients and doctors alike. There's nothing really new about that.

What's new this time is this: the pace of change outside of healthcare is changing.

AI. 3D printing. Robotics. Sensors. Programmatic tools to edit genes.

These trends are converging. Creating new combinations.

So what?

Majority of the GI space circles around traditional procedures such as colonoscopy. Patients have abdominal pain or are at risk of colon cancer. GI doctors perform colonoscopies. Bill for them. Insurances reimburse. Even software is developed around these themes.

But this everyday model for GI is changing. Not exactly because of changes in GI. Not even limited to changes within healthcare.

But because of changes outside of healthcare.

And when you delve into one specialty, it has the potential to tell you the story of all others.

That's exactly why it's important to connect these dots.