The Smart Toilet can provide invaluable information to gastroenterologists.

Scientists at Duke University’s Center for Water, Sanitation, Hygiene and Infectious Disease (WaSH-AID) have developed Smart Toilet, an AI tool that can be retrofitted into standard toilets to collect information from patients’ feces. Gastroenterologists can use this data for the treatment of various gut diseases including irritable bowel syndrome (IBS). (Duke TODAY)

Gastrointestinal (GI) diseases in the US entail 54 million ambulatory visits and 15 million visits to emergency departments each year.

The annual healthcare cost of $135.9 billion for GI disease in the US is higher, for example, than heart disease ($113.4 billion) (Peery 2019), and is likely to increase.

Duke investigated the integration into a sampling toilet of fecal biomarkers for biochemical diagnostics for many acute and chronic GI conditions, such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and colorectal cancer.

Duke’s Smart Toilet

The AI tool developed by Duke scientists can be fitted into existing standard toilet piping. It takes an image of the stool as it is flushed through the pipe. The tool can detect the type of stool (i.e., loose, normal, or constipated) and whether blood is present.

The AI tool was trained on 3,328 images of stools that had been annotated by gastroenterologists according to the Bristol Stool Scale, which is used to classify stools. The AI tool was a convolutional neural network (CNN), a type of deep learning algorithm that can analyze images.

On testing, the algorithm could identify the form of the stool with 85% accuracy. It detected blood correctly in 76% of the images.

“Patients often can’t remember what their stool looks like or how often they have a bowel movement, which is part of the standard monitoring process,” said Deborah Fisher, MD, associate professor of medicine at Duke University and one of the lead authors on the study. “The Smart Toilet technology will allow us to gather the long-term information needed to make a more accurate and timely diagnosis of chronic gastrointestinal problems.”

“We are optimistic about patient willingness to use this technology because it’s something that can be installed in their toilet’s pipes and doesn’t require the patient to do anything other than flush,” said Sonia Grego, Ph.D., founding director of the Duke Smart Toilet Lab and a lead researcher on the study. “This could be especially useful for patients who may not be able to report their conditions, such as those who live in a long-term care facility.”

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