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Designing a mobile app to help patients and doctors identify personalized food triggers

IMG_2894As a fellow in the Stanford Biodesign and Gastroenterology programs, Jasmine Zia, MD, knew she wanted to combine her two passions, medicine and engineering, to create a device that would improve the delivery of patient care. But it wasn't until she was back in the hospital closely observing the daily challenges of patients and doctors that she and her teammate, Raymond Bonneau, got the idea for an iPhone app to help patients diagnosed with irritable bowel syndrome understand how eating patterns might improve or aggravate their symptoms.

Zia recently presented (.pdf) on the app at Stanford before graduating and accepting a faculty position in the Department of Gastroenterology at the University of Washington in Seattle. In light of the growing popularity of the self-tracking movement, I was interested to learn more about her project and how the app could be used in a clinical setting. Below she discusses designing the app, the role patients played in its development, and a pilot study completed at Stanford.

Can you briefly describe how your mobile app works?

Our app, called Gut Guru, asks patients to log their meals and bowel symptoms every day for two to four weeks. This entered data is presented in a concise and organized manner on a separate screen for both users and their providers to see. Once enough data is acquired from a patient's diary, a machine learning and pattern recognition algorithm will be applied to this data. Over time, this data will build a predictive model of symptom severity to help identify individualized food triggers.

What motivated your group to develop a tool for identifying food triggers?

Time and time again in my clinics and during hospital rounds, I was struck by how many affected patients, especially those suffering from irritable bowel syndrome (IBS), endorsed having their gastrointestinal symptoms triggered from certain foods. Prior focus groups report up to 70 percent of IBS patients endorsing food triggers. As the medical literature of functional gastrointestinal disorders and food is building, we felt motivated to bridge the gap between what we are learning from research to its practical applications in everyday life for real patients. Instead of giving a huge list of potential foods patients should avoid, we are developing a mobile app to help identify personalized food triggers for patients with irritable bowel syndrome to reduce one's gastrointestinal symptoms, thereby improving their quality of life.

In designing the app, what specific problems did the team address?

By designing the app, we hope to address [three things]: a more complete and reliable patient food and symptom diary, a more organized presentation of the accumulated data for easier interpretation by both patients and providers, and a more validated and objective methodology for determining personalized trigger foods from a patient's food and symptom diary.

At present, paper diaries formatted by patients are incomplete due to both limited instructions provided by the busy clinician and low compliance rates associated with the design of freehand pen-and-paper diaries. Prior studies in other chronic disease have clearly demonstrated the superiority of electronic diaries over paper diaries in both completeness and compliance rates.

Patients currently present the data from their food and symptom diaries to their providers in whatever format they choose. Anecdotally, this means pages of disorganized scribbled notes. Providers do not have enough time to go through these paper diaries during a single 20-minute clinic visit.

Finally, clinicians do not receive formal training during their medical career on how to determine individualized trigger foods from a food and symptom diary. There are presently no accepted guidelines instructing providers on how to interpret the data provided from a food and symptom diary.

IBS patients and their medical providers need a more reliable way to individualize dietary modifications to reduce a patient's bowel symptoms.

How did your interactions with patients at Stanford influence the development of the app?

IBS and other functional gastrointestinal disorders are prevalent and account for 50 percent of all initial gastroenterology consultations. IBS alone is estimated to affect up to 20 percent of the United States population. At best, most traditional IBS medications have marginal therapeutic gains over placebo of 7 to 15 percent. Most are geared towards reducing, not preventing, bowel symptoms. Much of this stems from the fact that the pathophysiology of IBS is not completely understood at this time, making the development of effective treatments challenging.

As a provider, I was frustrated for my IBS patients because I was limited in my ability to help alleviate their symptoms using traditional medications. I'm sure they were even more frustrated than me given that they suffered from their symptoms daily. This is what made me look into alternative therapies for IBS, eventually leading me to dietary modifications. Previous clinical studies have demonstrated patient adherence to certain diets have resulted in symptom reductions twice the magnitude of their IBS pharmacological counterparts, when both modes of therapies were compared to placebo.

You conducted a pilot study on Gut Guru at Stanford. What did the study involve? Can you share any insights from the preliminary findings?

An ongoing preliminary pilot study at Stanford has shown that IBS patients found our app easy to use with no significant fatigue from entering data over a two-week period, a pitfall often found in other mobile apps. The compliance rate was over 90 percent. We're anxiously waiting to see how the use of Gut Guru it will affect their bowel symptoms and quality of life.

Zia and Bonneau hope Gut Guru will be available in the Apple App Store within the next year. At this time, they plan to make the food diary portion of the app available for free, but they plan to charge a fee for the analytic portion for the app. The next version of the app is expected to be compatible with other mobile devices, including Android phones.

Previously: Stanford pediatric gastroenterologist answers your questions on inflammatory bowel diseases and Spreading awareness of inflammatory bowel disease, one bathroom stall at a time
Photo by iamtheo

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