Abstract:
A multi-sensor wireless abdominal monitoring system comprising a low-profile belt that fits around the abdomen and is embedded with specialized wireless sensors. The system is configured to continuously monitor a range of gastrointestinal and abdominal wall functions. The system wirelessly transmits data to an external device, such as a smartphone or computer for storage and download to a central server. The acquired data may be monitored remotely through specialized software that generates clinically interpretable information presented through a graphical user interface. The device provides data that are immediately actionable for a wide range of inpatients and outpatients with high prevalence disorders in varied clinical settings.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a 35 U.S.C. §111(a) continuation of PCT international application number PCT/US2013/057680 filed on Aug. 30, 2013, incorporated herein by reference in its entirety, which claims priority to, and the benefit of, U.S. provisional patent application Ser. No. 61/697,951 filed on Sep. 7, 2012, incorporated herein by reference in its entirety. Priority is claimed to each of the foregoing applications. 
         [0002]    The above-referenced PCT international application was published as PCT International Publication No. WO 2014/039404 on Mar. 13, 2014, which publication is incorporated herein by reference in its entirety. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
       [0003]    This work was supported by the U.S. Department of Veterans Affairs, and the Federal Government has certain rights in the invention. 
     
    
     INCORPORATION-BY-REFERENCE OF COMPUTER PROGRAM APPENDIX 
       [0004]    Not Applicable 
       NOTICE OF MATERIAL SUBJECT TO COPYRIGHT PROTECTION 
       [0005]    A portion of the material in this patent document is subject to copyright protection under the copyright laws of the United States and of other countries. The owner of the copyright rights has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the United States Patent and Trademark Office publicly available file or records, but otherwise reserves all copyright rights whatsoever. The copyright owner does not hereby waive any of its rights to have this patent document maintained in secrecy, including without limitation its rights pursuant to 37 C.F.R. §1.14. 
       BACKGROUND OF THE INVENTION 
       [0006]    1. Field of the Invention 
         [0007]    This invention pertains generally to abdominal monitoring, and more particularly to monitoring for abdominal dysfunctions. 
         [0008]    2. Description of Related Art 
         [0009]    To our knowledge, there are currently no commercially-available systems that provide continuous, wireless, abdominal physiologic monitoring across the spectrum of abdominal dysfunctions that we describe herein. The “state of the art” includes conducting intermittent abdominal examinations with a stethoscope and manual palpation. 
       BRIEF SUMMARY OF THE INVENTION 
       [0010]    One aspect of the present invention is a multi-sensor wireless abdominal monitoring system comprising a low-profile belt that fits around the abdomen and is embedded with specialized wireless sensors. The system is configured to continuously monitor a range of gastrointestinal and abdominal wall functions. The system wirelessly transmits data to an external device, such as a smartphone or computer for storage and download to a central server. The acquired data may be monitored remotely through specialized software that generates clinically interpretable information presented through a graphical user interface. The device provides data that are immediately actionable for a wide range of inpatients and outpatients with high prevalence disorders in varied clinical settings, discussed below. 
         [0011]    The system and methods of the present invention accomplish some or all of these functions (1) real-time acoustic monitoring to measure the continuous sounds of motility emanating from the gastrointestinal tract and to measure heart rate by monitoring abdominal arterial pulse; (2) abdominal girth monitoring to measure static and dynamic changes in abdominal circumference over time; (3) electromyography to measure contractions of the anterior abdominal musculature; (4) motion sensing to infer breathing rate and other forms of movement; (5) galvanic skin conductance to infer emotional or physical stress; and (6) global positioning to track movement and location. 
         [0012]    Another aspect of the present invention is a multi-sensor abdominal monitoring system incorporating a low-profile belt that fits externally around the abdomen and is embedded with specialized wireless sensors. 
         [0013]    In one embodiment, the system is configured to continuously, safely, and comfortably monitor intra-abdominal acoustic signals and abdominal girth, and stores the data in a HIPAA compliant hard drive. 
         [0014]    In another embodiment, the system is configured to wirelessly transmit data to a smartphone for storage and download to a central server. The data from AbStats are monitored by specialized software that will generate clinically interpretable information presented through a graphical user interface. The system is configured to provide data that are immediately actionable for a wide range of inpatients and outpatients with high prevalence disorders in varied clinical settings. 
         [0015]    In another embodiment, the system provides real-time acoustic monitoring to measure the continuous sounds of motility emanating from the gastrointestinal tract. In addition, it may be configured to measure abdominal girth to monitor static and dynamic changes in abdominal circumference over time. 
         [0016]    As discussed in detail, below, the present invention provides a novel tool for patients and providers to track disease between scheduled visits, and offers the general public a way to quantify their own physiology. 
         [0017]    Further aspects of the invention will be brought out in the following portions of the specification, wherein the detailed description is for the purpose of fully disclosing preferred embodiments of the invention without placing limitations thereon. 
     
    
     
       BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING(S) 
         [0018]    The invention will be more fully understood by reference to the following drawings which are for illustrative purposes only: 
           [0019]      FIG. 1  is a top schematic view of a multi-sensor wireless abdominal monitoring system in accordance with the present invention. 
           [0020]      FIG. 2  is a schematic side view of the waist belt and digital stethoscope-type transducer of  FIG. 1 . 
           [0021]      FIG. 3  is a schematic diagram illustrating an exemplary array of apertures configured to receive individual sensors in accordance with the present invention. 
           [0022]      FIG. 4A  is a schematic top view of an abdominal girth sensor system in accordance with the present invention that comprises a compliant belt that may be worn around the abdomen of a user. 
           [0023]      FIG. 4B  is a schematic diagram that shows the sensor system of  FIG. 4A  with an abdominal expansion of the belt. 
           [0024]      FIG. 5  is a schematic diagram for a system architecture for the wireless abdominal monitoring systems shown in  FIG. 1  through  FIG. 4B . 
           [0025]      FIG. 6  is a flow diagram for a sensor fusion process in accordance with the present invention. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0026]    A. System Description 
         [0027]    1. Acoustic Sensor Belt and System 
         [0028]    Referring to  FIG. 1 , one embodiment of the multi-sensor wireless abdominal monitoring system  10  comprises a plurality of low profile highly focused acoustic sensors  12  that are applied to the anterior abdominal wall  16 , e.g. to perform acoustic monitoring to measure the sounds of motility emanating from the gastrointestinal tract and to measure heart rate by monitoring abdominal arterial pulse. 
         [0029]      FIG. 1  illustrates a system  10  with a four-sensor linear array of digital stethoscope transducers  12  according to a preferred embodiment of the invention. The sensors  12  are supported by an elastic waist belt  14  that is configured to circumscribe the patient&#39;s abdomen  16 . 
         [0030]    It will be appreciated that other sensor configurations are possible as needed for multiple-sensor scenarios. In case of a 2-sensor system, with one sensor positioned on waist belt  16  such that it lines up adjacent to the right lower quadrant of the abdomen  16  over the region of the ileocecal valve (not shown), and the other sensor  12  lining up adjacent the left lower quadrant of the abdomen  16  over the sigmoid colon (not shown). 
         [0031]    These acoustic sensors  12  are configured to continuously and non-invasively monitor and capture a range of audio signals which represent gastrointestinal and abdominal wall functions. The captured data is recorded by the system  10  in a synchronized manner from all onboard sensors  12 . The data acquired by the sensors  12  are fed to a control unit  20  housing signal processing and data acquisition components. A data acquisition unit  24  and processor  22  acquire the raw data from the sensors  12 . The unit may have a user interface  26  for user manipulation of the device, and memory  28  for storing the acquired data and/or programming associated with data acquisition/signal processing. A wireless transceiver  30  may also be included for transferring the acquired sensor data and/or configuration data to a central repository or database (not shown). 
         [0032]      FIG. 2  shows a schematic side view of the waist belt and digital stethoscope-type transducer  12 . The sensor has a sensing face  54  with a diameter D outer  larger than the waist section  52  diameter D inner  and top portion  50 . Thus, the sensor  12  is supported within an aperture  40  (see  FIG. 3 ) of the belt  14 . 
         [0033]      FIG. 3  shows an exemplary array  42  of apertures  40  configured to received individual sensors. Each aperture  40  is preferably sized to have a diameter matching the diameter D inner  of the sensor  12  waist section  52 . It is appreciated that array  42  may be configured with any number or pattern of apertures  40 . 
         [0034]    While sensors  12  shown in  FIG. 1  through  FIG. 3  are illustrated with respect to one or more acoustic sensors for monitoring and capturing a range of audio signals which represent gastrointestinal and abdominal wall functions, it is also appreciated that other types of sensors may be employed in combination with or in alternative to, said acoustic sensors. For example, sensors  12  may comprise one or more of capacitance measuring electrodes for abdominal girth monitoring to measure static and dynamic changes in abdominal circumference over time; electromyography sensors to measure contractions of the anterior abdominal musculature; motion sensors to infer breathing rate and other forms of movement; galvanic skin conductance sensors to infer emotional or physical stress; and global positioning sensors to track movement and location. 
         [0035]    2. Abdominal Girth Sensor 
         [0036]      FIG. 4A  and  FIG. 4B  show top views of an abdominal girth sensor system  100  in accordance with the present invention that comprises a compliant belt that may be worn at the abdomen  16  of a user. System  100  is configured for both wearable, convenient usage as well as support of other sensors. In addition, the girth sensor  100  can be integrated with other garments and systems that assist clinical usage as well. 
         [0037]    System  100  uses an outer elastic housing  120  and inner elastic housing  122  that entrain an inelastic inner belt  124 . The elastic characteristics of belt  100  may be adjusted by selection of materials (for example Lycra or other elastic fabric for housings  120  and  122 ). The inelastic belt  124  is preferably composed of a mechanically non-compliant material (e.g. nylon cloth or the like fabric), which is attached to the outer elastic housing  120  and inner elastic housing  122  at its the ends  126 ,  128 . 
         [0038]    The inner belt  124  is equipped with a flexible, conducting fabric electrode array  130 . At one end  126  of the inner inelastic belt  124  is a single inner capacitor electrode  134 , and at its opposite end  128  is the outer linear capacitor electrode array  130 . While eight electrodes  132  are shown to comprise the array  130  in  FIG. 4A  and  FIG. 4B , it is appreciated that system  100  can be implemented with many more electrodes  132 , e.g. preferably over 64 electrodes  132 . 
         [0039]    Integrated capacitance detection elements  132 ,  134  of the inner belt  124  are configured to detect relative motion and provide an absolute circumference and girth measurement.  FIG. 4A  shows the belt  100  in an initial configuration.  FIG. 4B  shows the belt  100  after an expansion of the abdomen, resulting in free end  126  and sensor  134  moving distance D with respect to the array  130 . 
         [0040]    In a preferred embodiment, the electrodes  132  are addressed by controller (e.g. see controller  20  of  FIG. 1 ) that comprises an analog multiplexor component and a standard capacitance detection circuit (both not shown) to enable access to each electrode  132 . As shown in  FIGS. 4A and 4B , when girth expansion occurs, a relative displacement D occurs at the ends  126  and  128  of the inelastic belt  124 . This displacement D changes the position of the electrode  134  with respect to electrodes  132  in array  130 . Since measured capacitance depends on the location of the inner  134  and outer electrodes  132 , then displacement and girth can therefore be measured. 
         [0041]    3. Monitoring System Architecture 
         [0042]      FIG. 5  shows a preferred embodiment for a system architecture  200  for the wireless abdominal monitoring systems  10 ,  100  shown in  FIG. 1  through  FIG. 4B . System architecture  200  uses a sensor fusion module  204  for the identification, classification, and notification of events and conditions related to digestive and abdominal health. System architecture  200  links multiple sensors (e.g. sensors  12  or  132  in  FIG. 1  through  FIG. 4B ) at the user  16  and provides classification analytics  230  capabilities at the sensor fusion module  204 , and at the local wearable gateway  20 , or via data transport  220  to a smartphone (e.g. Android gateway  222  for receiving data from sensors  12 ,  132 ) or PC  202  with web and media browser  224  for user  16  access. Sensor fusion module  204  combines data from multiple acoustic sensors  208  as well as an archive  206  diverse sensor systems including those of abdominal girth, electromyography, and others. 
         [0043]    A web services module  214  may be included to provide guidance through services such as messaging, media, fax, etc. User and healthcare provider support module  210  provides data analysis modules to access the data and provide extended functionality such as alerts, compliance mechanisms, patient information, device and training registration, etc. 
         [0044]    The system  200  allows for the tracking of patient usage compliance, patient measurement trend analyses, user and device management, and provides a method for improving compliance in gastrointestinal healthcare. 
         [0045]    System  200  may also include an audio component  212  for providing analytics within an augmented audio signal delivery interface. This provides remote access to human audible signals as acquired at the patient  16 . A clinician, trained technician, or the user may be provided with this source that itself may include processing for reduction of noise and enhancement of desire features. The augmented audio signal interface  212  may employ standard methods for removal of noise and/or echo sources, or commercially available audio signal processing. 
         [0046]    Monitoring system architecture  200  is illustrated in  FIG. 5  with the user (patient)  16  at left and equipped with one or more of the sensor systems  12 ,  132  that emphasize acoustic sensing, but may also include electromyography and many others. Sensor data is preferably transported via data transport  220  (which may include transceiver  30 ) to a smartphone or other computing platform  203  where a gateway system (e.g. Android software implementation 22) provides data transport to the classification analytics system  230 . The same smartphone or other computing platform  202  may also provide the user with access to data by methods that may include but are not limited to web user interfaces  224 . Data arriving at the classification analytics system  230  may then be processed by methods including sensor fusion module  204 . Then data may be made available to healthcare providers and partners via module  210 . At the same time, clinicians and others may be presented with audible sound sources from module  212  via remote access (including telephony and Web based methods) for interpretation. Further guidance information derived from services module  214  may also be provided to the user  16 . 
         [0047]    4. Data Flow and Analytics 
         [0048]    The systems  10 ,  100  acquire data via acoustic sensing at the subject  16 . Multiple sensors (e.g.  12 ,  132 ) are generally applied at multiple abdominal locations. Acquired data may be processed at the local wearable computing gateway  20  or transported via wireless and/or Internet services to smartphone/PC  202  or analytics server  230  shown in  FIG. 5 . The system  10 ,  100  may also store data locally within memory  28  at the wearable gateway  20 , enabling operation independent of network interfaces. 
         [0049]    An integral component of the analytics functionality of system  200  is sensor fusion module  204 .  FIG. 6  shows sensor fusion process  250  which acquires sensor data at step  252  to generate an acoustic feature set for each sensor site via frequency and time domain signal processing at step  254 . Bayesian sensor fusion/classification is then applied at step  256  to producing an inference regarding subject state/condition. Step  256  may also include as input subject data  260  and training data  262  based on a library of signals obtained in trials on subjects of known state. Additional sources of evidence, including abdominal girth and other clinical measures, may also be included. 
         [0050]    In the feature set step  254 , acoustic or other signal sources are processed to extract features that may include but are not limited to: amplitude, primary frequency components, time of occurrence of signals and coincidence of signals. The features from step  254  are then applied as an input to a classifier as step  256 , which may include, but is not limited to, a selection of Bayesian classifiers. As mentioned above, the Bayesian classifier produces an output computation corresponding to an inference for the subject condition at step  356 . Preparation of the Bayesian classifier by training process steps  260 ,  262  is based on the presentation of feature sets for corresponding patient condition and for many patient conditions. Through this training process, the Bayesian classifier  256  acquires the capability to infer the actual subject state from knowledge only of features. Data from multiple sensors  12 ,  132  may be acquired at step  252  by a time-synchronized sampling method and then stored and made available in either real time or at a later time to the computational system  200  supporting sensor fusion. 
         [0051]    The analytics is then followed by guidance at step  258  delivered to users and caregivers. These include alerts regarding change in subject condition, time profiles of specific subject states, guidance for users and caregivers, and information regarding trends. 
         [0052]    B. Clinical Applications 
         [0053]    Systems  10 ,  100 ,  200  and method  250  may be useful in a broad spectrum of patients and indications. Exemplary indications may be found in Table 1 below, and include: 
         [0054]    1. Monitoring-patients with post-operative ileus. Most every patient develops temporary bowel paralysis following thoracic, abdominal, or pelvic surgeries. Clinicians monitor stool output and bowel sounds to determine when it is safe to begin re-feeding and to plan hospital discharge. Patients with prolonged bowel paralysis can require additional hospital days and excessive stays. With system  10  and  200 , patients may be monitored continuously, and data be made available on a web-based dashboard (e.g. web interface  210 ) for real-time evaluation. After establishing normative and predictive standards for our invention, providers will more reliably determine who is recovering quickly based on acoustic and abdominal girth monitoring, and who may require additional close observation. For example, patients with early evidence of motility and resolving abdominal distension, detected by our invention, acoustic monitoring and abdominal circumference tracking, may be fed earlier and discharged sooner than might otherwise occur without use of our invention. 
         [0055]    2. Monitoring in-patients with an “acute abdomen.” Patients with an acute abdomen are highly prevalent in medical, surgical, pediatric, and obstetrical inpatient wards, and include those with acute cholecystitis, pancreatitis, appendicitis, colitis, diverticulitis, bowel ulcerations or perforations, and bowel obstructions, among many other conditions. These high acuity patients often have a dynamic and unpredictable clinical course and require frequent monitoring. Although acutely ill patients often have continuous cardiovascular and pulmonary monitoring, they do not have continuous abdominal monitoring. Yet, changes in the abdomen almost always precede changes in cardiovascular and pulmonary function in patients with acute abdominal disorders. Our invention will provide real-time data on a range of functions in acutely ill GI patients. For example, patients with progressive disease often exhibit “peritoneal signs” marked by abdominal wall contractions from pain, detectable through electromyography. They may develop abdominal distension in the setting of progressive ileus or bowel obstruction, monitored continuously through abdominal girth measurements. They may develop intermittent high-pitched bowel sounds from obstruction, measured continuously through acoustic monitoring. Furthermore, they may develop other evidence of distress, marked by a combination of increased skin conductance, heart rate, and respiratory rate—all measurable through the use of the systems  10 ,  100  of the present invention even without concurrent cardiopulmonary monitoring. The systems  10 ,  100  are invaluable to predict clinical decrement earlier than otherwise possible. Conversely, the systems  10 ,  100  may reveal signs of clinical stabilization in ways not easily detected through usual clinical approaches, which rely upon intermittent check-ups throughout the day—not continuous data monitoring of abdominal physiology. A 30 second abdominal examination cannot provide reliable data about what has occurred, or will occur, in the course of a day—it can only provide data about the immediate moment in time. Thus, there is an extensive need for continuous abdominal physiological monitoring, especially in patients with acute abdominal processes. 
         [0056]    3. Monitoring inpatients in intensive care units. Even in the absence of an “acute abdomen,” abdominal monitoring is standard of care in all patients, especially those in intensive care units. Of note, this is especially important for patients who cannot easily verbalize their abdominal symptoms, regardless of abdominal acuity, including patients who are demented, delirious, comatose, sedated, intubated, or infants or children with limited verbal capacity. In addition, patients in intensive care often receive narcotics for pain control, which themselves lead to diminished bowel motility and risk of ileus or Ogilve&#39;s syndrome (colonic inertia). Patients in intensive care may also develop intra-abdominal infections or inflammatory conditions that are easily missed in their early phase. The systems  10 ,  100  of the present invention accurately detect these conditions earlier than usual by demonstrating increased abdominal wall contractions—a sign of abdominal pain. The systems  10 ,  100  are also configured to monitor bowel sounds as a screen for progressive ileus from medications or intra-abdominal processes, and detect early signs of bowel obstruction through monitoring abdominal circumference, coupled with acoustic and electromyographic data. 
         [0057]    4. Monitoring outpatients with ascites. Cirrhosis is highly prevalent, and ascites (abdominal fluid accumulation) is a common complication of portal hypertension in chronic liver disease. Ascites also occurs in a range of other conditions, including abdominal infections and cancer. Patients with ascites can be difficult to manage and require frequent changes in their diuretic (water pill) dosing, amount of sodium restriction, and dietary composition. The systems  10 ,  100  of the present invention provide a novel and actionable way to monitor ascites in outpatients with cirrhosis. In patients with recurrent or recalcitrant ascites, continuous monitoring with the systems  10 ,  100  provide deep insight into the progression and timing of fluid accumulation within the abdomen. The systems  10 ,  100  can detect worsening of ascites by remotely reporting evidence of abdominal distension and diminished amplitude of bowel acoustics, suggesting increased distance between the sensor and intestinal track from interposed fluid accumulation. The systems  10 ,  100  can alert healthcare providers if there is a marked change in abdominal circumference within set parameters, allowing providers to intervene long before the patient might otherwise be scheduled for the next clinic visit. Additionally, the data can be reviewed over a several week course to evaluate for trends. For example, the “electronic ascites journal” provided by our invention might reveal consistent worsening on Mondays. Upon further evaluation, the patient might admit to salt-heavy dinners on Sunday nights. The clinical plan would be clear: either cutback on the salty dinners on Sunday night, or increase the dose of diuretics on Sunday in advance of Monday&#39;s clinical fall-out. Without the systems  10 ,  100  of the present invention, this discussion would probably never occur. 
         [0058]    5. Monitoring inpatients and outpatients receiving narcotics for acute or chronic pain. Narcotics are commonly used in healthcare. Patients with chronic pain, in particular, are highly prevalent in both the inpatient and outpatient settings. A major complication of narcotics is bowel paralysis, leading to ileus or even Ogilve&#39;s syndrome (colonic inertia). For inpatients, bowel paralysis can lead to prolonged stays and increased healthcare costs. For outpatients, bowel paralysis can impact compliance with otherwise effective therapies. For both groups, narcotics cause disruptive consequences of GI distress, and ultimately diminished health related quality of life. Other than following patient symptoms in a reactive manner, the systems  10 ,  100  allow proactive management of all patients on narcotics, especially those just beginning narcotics and those struggling to find the correct dose. With systems  10 ,  100 , providers can monitor the cause-and-effect consequences of narcotics, and employ these data to optimize the correct dose and timing. For example, patients with progressive signs of bowel paralysis and abdominal distension should have their dose reduced to compensate. Patients with persistent pain and normal bowel function might require higher or more frequent therapeutic dosing. In short, systems  10 ,  100  provide a new paradigm in how to manage and optimize the care of patients on narcotics. 
         [0059]    6. Monitoring outpatients with inflammatory bowel disease (IBD). 
         [0060]    Inflammatory bowel diseases, including Crohn&#39;s disease and ulcerative colitis, are common conditions in GI practice. Patients with Crohn&#39;s Disease, in particular, often suffer from intermittent bowel obstructions related to intestinal strictures. Managing these patients can be challenging and not well suited to the usual approach of intermittent appointments and clinic visits. The disease can be dynamic, and bowel obstructions may occur between clinic visits, leading patients to the emergency department for urgent management. With wireless monitoring provided by systems  10 ,  100 , healthcare providers can monitor their IBD patients in real-time, and identify early signs of bowel obstruction remotely, accurately, and quickly. For example, the systems  10 ,  100  might reveal evidence of increasing frequency of high amplitude bowel sounds over the course of several days, along with increased frequency of abdominal wall contractions, increases in heart rate, galvanic skin resistance, and respiratory rate. Patients themselves may detect these early changes as well, but decide to wait for their scheduled visit, or opt to wait until the symptoms pass. However, providers may interpret the data differently, allowing them to proactively contact their patient, potentially modify therapy, or schedule an earlier appointment. If coupled with patient reported symptoms entered through the system, the marriage of informatics and patient reporting would enrich the data even further. 
         [0061]    7. Diagnosis of outpatients with unexplained abdominal pain. 
         [0062]    Chronic or recurrent abdominal pain is highly common both in GI and general medicine clinics. Although various imaging tests are commonly used to evaluate the source of pain (e.g. computerized tomography, magnetic resonance, etc.), there are very few functional tests of abdominal physiology. Most tests of abdominal function (e.g. esophageal or gastric motility, “Smartpill,” Sitzmark studies, etc.) are highly specialized, invasive, expensive, and limited to specialized motility centers. Moreover, these tests only measure health over a short period of time, typically much less than a day. In contrast, systems  10 ,  100  provide continuous physiologic data over prolonged periods. When coupled with a diary of patient reporting, systems  10 ,  100  provide concurrent data to better understand the underlying physiology leading up to, during, and after pain flares. 
         [0063]    8. Diagnosis of outpatients with abdominal bloating. Bloating is among the most common symptom experienced by people in the community, and certainly in GI practices. Despite being common, little is known about its pathophysiology, and even less is available to manage the condition. However, there are ways to manage bloating if they are aligned with the underlying physiology. For example, most patients with bloating have a learned reflex where the anterior abdominal wall is actively relaxed, forcing the abdomen to literally “pooch out” with lowering of the diaphragm. This form of “functional bloating” is different from increased intra-abdominal gas, where the abdominal wall does not relax. By measuring abdominal circumference with abdominal electromyography and bowel acoustics, providers can better establish whether bloating is from abnormal gas handling, abnormal motility, or abdominal wall relaxation. The treatment approach is different for each type of bloating (as different as behavioral modifications versus antibiotics). Absent the systems  10 ,  100  of the present invention, there is currently no way to monitor bloating outside of specialized protocols run over short time periods. 
         [0064]    9. Diagnosis of outpatients with nausea and vomiting. Nausea and vomiting are highly disruptive symptoms. Although the underlying etiology is often apparent from diagnostic testing, many patients continue to have unexplained nausea and vomiting despite costly and extensive work-ups. The systems  10 ,  100  provide another tool to help understand the sequence of events surrounding bouts of nausea and vomiting. When placed in the epigastrium, the systems  10 ,  100  measure gastric acoustics and infer the frequency and amplitude of gastric motility—especially relevant in gastroparesis, such as in patients with advanced diabetes. The systems  10 ,  100  further provide information on the sequence of key physiologic events, including motility, abdominal contractions, and stress, among other functions. The systems  10 ,  100  will also detect when a patients is likely eating, and how far between meals the nausea and vomiting occur. It is expected that systems  10 ,  100  will reveal new and previously unknown physiologic patterns and sequences related to otherwise unexplained nausea and vomiting. 
         [0065]    10. Diagnosis of outpatients with diarrhea and/or fecal incontinence. 
         [0066]    Patients with diarrhea and incontinence may suffer from many different conditions with different physiologic mechanisms. Patients with fecal incontinence, in particular, can be difficult to diagnose and treat. The systems  10 ,  100  provide another tool to help understand reasons for diarrhea and incontinence. For example, if systems  10 ,  100  detected a mass colonic movement in advance of fecal incontinence, it would suggest the otherwise normal anorectal function was overwhelmed by volume, and argue against intrinsic dysfunction of anorectal mechanisms. In contrast, if mass movements did not precede fecal incontinence, then it would suggest that anorectal dysfunction was the most likely explanation. In addition, systems  10 ,  100  can track motility in relation to meals, stress, and other physiologic events. The data might reveal patterns that are explanatory and clinically actionable. 
         [0067]    11. Diagnosis of outpatients with constipation. Constipation is also extremely common. Gastroenterologists divide constipation into 3 major forms: (1) slow transit, (2) normal transit, and (3) pelvic dyssynergia. There are invasive tests to help separate these forms of constipation, but they are expensive, only available in specialized centers, and provide only short-term data. The systems  10 ,  100  provide another tool to better understand the underlying mechanisms of constipation. For example, patients with constipation despite evidence of colonic peristalsis likely have either “normal transit” or pelvic dyssynergia causing their constipation. In contrast, lack of peristalsis would suggest “slow transit” constipation. The treatments are very different. 
         [0068]    12. Monitoring and further diagnosis of outpatients with irritable bowel syndrome (IBS). IBS affects ˜10% of the world&#39;s population, and is among the most common conditions experienced by man. Marked by abdominal pain and defecatory symptoms, IBS is not only common, but also a significant impact on the quality of life. Current theories of IBS suggest an abnormality in the “brain-gut axis,” with both central and peripheral disease mechanisms. The “stress” theory of IBS suggests that GI symptoms arise from visceral anxiety driven through a combination of stress hormones and their function on GI physiology. Peripheral theories include abnormal motility, inflammatory changes in the intestines, and bacteria, among others. Patients with IBS have recurrent symptoms that can be dynamic and unpredictable. It is difficult to monitor the condition correctly, yet diagnostic and therapeutic decision making depends on valid and reliable patient reporting of their illness. The systems  10 ,  100  may revolutionize how we monitor and categorize patients with IBS. For example, patients with predominantly “central” mechanisms of IBS might develop stress initially, and GI physiologic abnormalities secondarily. These patients might develop changes in galvanic skin resistance, heart rate variability, and/or tachypnea in the minutes, hours, or even days before an “IBS flare.” This temporal relationship might indicate that stress is driving the GI symptoms, and not the other way around. In contrast, patients might first develop high-pitched bowel sounds, evidence of colonic mass movements, and diarrhea (itself evidenced through Valsalva maneuvers on electromyography, stable positioning in a known bathroom on GPS, and characteristics acoustic signals), and only then develop changes in galvanic skin resistance. This might suggest that peripheral mechanisms are predominant. 
         [0069]    13. Serve as a bowel diary. Regardless of the underlying condition, GI patients often need to keep an accurate bowel diary to help monitor disease, treatments, and collect diagnostic information for their providers. But bowel diaries are frequently inaccurate and patients often forget to complete the diary or even fail to begin. The systems  10 ,  100  provide an objective way to monitor bowel movement frequency and duration. Through electromyography, global positioning, and acoustic monitoring, our invention will infer when bowel movements are occurring. If coupled with other information, including dietary intake and composition, medicine intake and timing, and other external factors, systems  10 ,  100  provide insight about the timing and potential causes of constipation and diarrhea. 
         [0070]    14. Monitoring patients with high-risk abdominal aortic aneurysms (AAA). In the setting of cardiovascular diseases, such as hypertension, smoking, and hyperlipidemia, the abdominal aorta can develop atherosclerotic changes. Over time, this leads to aneurysm formation, itself potentially dangerous; aortic hemorrhage can be rapidly fatal. Patients with known “triple As” (AAA) are typically monitored with serial ultrasounds. But AAAs can change rapidly between scheduled ultrasounds. Continuous acoustic monitoring can listen to the continuous “hum” of an AAA, and track changes in the acoustic signature. Marked changes might indicate expansion or other morphological changes of the lesion, and therefore prompt more timely investigation before a potential catastrophe. The systems  10 ,  100  can be placed directly over an AAA in the supra-umbilical midline and continuously monitor and characterize the acoustic signature of an AAA. 
         [0071]    15. Monitoring infants with colic. Colic is common and troubling for infants and their parents. Colic can lead to abdominal pain and distress for the whole family. The systems  10 ,  100  can be used to provide better information about what is happening inside a colicky infant, identify early signs of colic, and provide a head start for parents to sooth or otherwise manage their infant prior to the peak of colic attacks. 
         [0072]    16. Monitoring infants or young children with GI disorders. Beyond colic, infants and children may develop a range of GI illnesses. Unlike adults, infants or children cannot reliably transmit their pain or distress. The systems  10 ,  100  may be used to provide early and objective signs of distress, including abdominal contractions, increased heart and breathing rates, galvanic skin resistance changes, and increased amplitude contractions. This can warn parents of impending or ongoing pain and help achieve more timely and effective disease-targeted therapies. 
         [0073]    17. Monitoring nursing home patients with diminished verbal ability. Similar to monitoring infants or young children, many nursing home patients have lost their ability to verbalize symptoms, especially pain. The systems  10 ,  100  can be used to provide objective, real-time data to suggest possible abdominal pain. 
         [0074]    18. Alerting caretakers to bowel movements in infants and toddlers. Caretakers often guess whether their infant or toddler has passed a bowel movement. The systems  10 ,  100  can be used to provide objective evidence when it occurs, and alert caretakers to check the diapers. 
         [0075]    19. Provide objective endpoints for clinical trials. There are few reliable and objective markers in GI clinical trials, especially for trials of functional GI disorders like IBS, or mal-digestive conditions like lactose intolerance. The FDA is focused on identifying valid and reliable markers for trials. The systems  10 ,  100  can be used to provide a unique way of testing drugs aimed at modifying GI physiology, and could become a standard for measuring the effect of GI old and new treatments. 
         [0076]    20. Provide self-monitoring capabilities, regardless of disease status. The “quantified self” movement is prompting people of all kinds to monitor their own physiology, regardless of underlying disease. “Gut feelings” are common and have, quite literally, visceral significance. The availability of a wireless, convenient, low profile, continuous abdominal monitoring device will be appealing to anyone curious about their own GI physiology. The systems  10 ,  100  can be used to fill a growing demand to provide self-monitoring GI functions. 
         [0077]    In addition to these indications in humans, the systems  10 ,  100  can be used to provide vital information in veterinary medicine, ranching, and dairy farming. For example, cattle often suffer from rumen sickness, which can kill cattle and severely undermine profits. However, early rumen abnormalities are marked by abnormal digestion and mixing; this can be monitored through acoustics. The systems  10 ,  100  can be used to predict which cattle are getting worse, and which are not. Early interventions may save the lives of ailing cattle and maximize profits. Similarly, the performance of race horses depends heavily on their GI health. Understanding and monitoring GI function in race horses may help to maximize success. The systems  10 ,  100  may also provide a novel and important way for owners and handlers to monitor the GI health of horses and other animals otherwise incapable of expressing their digestive health. 
         [0078]    In short, virtually every GI patient may potentially benefit from systems  10 ,  100  at some point in their diagnostic or therapeutic course. Moreover, the systems  10 ,  100  can be used for applications beyond GI patients, and include patients with cardiovascular diseases (e.g. aortic aneurysm) and patients without a defined GI illness simply interested in monitoring their own physiology. The systems  10 ,  100  may also have particular applicability in animals. The systems  10 ,  100  can be configured to be inexpensive, disposable, and widely available, and thus have applicability in multiple markets quickly, provide irreplaceable clinical data, offer a novel way for patients and providers to track disease between scheduled visits, offer the general public a way to quantify their own physiology. 
         [0079]    The systems  10 ,  100  can be configured to include low profile “stickers” (not shown) that adhere to the anterior abdominal wall. One sticker would be placed in the right lower quadrant over the region of the ileocecal valve, the other in the left lower quadrant over the sigmoid colon; other configurations may be possible as needed. The stickers would continuously and non-invasively monitor the same range of gastrointestinal and abdominal wall functions as the belt used in  FIG. 1  through  FIG. 4B . 
         [0080]    Data acquired by the systems  10 ,  100  for each of these applications includes acoustic signals acquired by a network of acoustic sensors worn at the abdomen (and in some case at other anatomical sites). Broadband acoustic signals over the range of at least from dc and to over 100 kHz is acquired. In addition to these signals, abdominal girth will be measured at multiple points along with other physiological variables including, but not limited to, electromyography (EMG) heart rate, respiratory rate and effort, blood pressure, multiple points of core temperature, blood oxygen saturation and others. In addition, patient reporting regarding patient sensation will be acquired along with time and history of nutrition. 
         [0081]    Table 1 below presents which data would be acquired for key clinical indications, how the data would be correlated with diagnosing and/or treating a condition, and what diagnosis or treatment protocols would be employed on the basis of data recording and interpretation according to our invention. 
         [0082]    Embodiments of the present invention may be described with reference to flowchart illustrations of methods and systems according to embodiments of the invention, and/or algorithms, formulae, or other computational depictions, which may also be implemented as computer program products. In this regard, each block or step of a flowchart, and combinations of blocks (and/or steps) in a flowchart, algorithm, formula, or computational depiction can be implemented by various means, such as hardware, firmware, and/or software including one or more computer program instructions embodied in computer-readable program code logic. As will be appreciated, any such computer program instructions may be loaded onto a computer, including without limitation a general purpose computer or special purpose computer, or other programmable processing apparatus to produce a machine, such that the computer program instructions which execute on the computer or other programmable processing apparatus create means for implementing the functions specified in the block(s) of the flowchart(s). 
         [0083]    Accordingly, blocks of the flowcharts, algorithms, formulae, or computational depictions support combinations of means for performing the specified functions, combinations of steps for performing the specified functions, and computer program instructions, such as embodied in computer-readable program code logic means, for performing the specified functions. It will also be understood that each block of the flowchart illustrations, algorithms, formulae, or computational depictions and combinations thereof described herein, can be implemented by special purpose hardware-based computer systems which perform the specified functions or steps, or combinations of special purpose hardware and computer-readable program code logic means. 
         [0084]    Furthermore, these computer program instructions, such as embodied in computer-readable program code logic, may also be stored in a computer-readable memory that can direct a computer or other programmable processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the block(s) of the flowchart(s). The computer program instructions may also be loaded onto a computer or other programmable processing apparatus to cause a series of operational steps to be performed on the computer or other programmable processing apparatus to produce a computer-implemented process such that the instructions which execute on the computer or other programmable processing apparatus provide steps for implementing the functions specified in the block(s) of the flowchart(s), algorithm(s), formula(e), or computational depiction(s). 
         [0085]    From the discussion above it will be appreciated that the invention can be embodied in various ways, including the following: 
         [0086]    1. An abdominal monitoring system, comprising: a belt configured to be positioned around the waist of a user; one or more sensors coupled to the belt; wherein the belt is configured to support the one or more sensors such that the one or more sensors are positioned adjacent the abdominal wall of the user; and wherein the sensors are configured to receive signals from the abdominal wall; and a controller coupled to the one or more sensors; said controller configured for acquiring data relating to the signals. 
         [0087]    2. A system as in any of the previous embodiments, wherein the one or more sensors comprise acoustic sensors configured to receive acoustic signals from the abdominal wall. 
         [0088]    3. A system as in any of the previous embodiments, wherein the acoustic sensors comprise digital stethoscopes transducers. 
         [0089]    4. A system as in any of the previous embodiments, wherein the acoustic sensors are configured to receive real-time acoustic signals relating to one or more of: gastrointestinal and abdominal wall functions, motility emanating from the gastrointestinal tract and heart rate via abdominal arterial pulse. 
         [0090]    5. A system as in any of the previous embodiments, wherein the one or more sensors comprise electromyography sensors to measure contractions of the anterior abdominal musculature. 
         [0091]    6. A system as in any of the previous embodiments, wherein the one or more sensors comprise motion sensors to infer breathing rate and other forms of abdominal movement. 
         [0092]    7. A system as in any of the previous embodiments, wherein the one or more sensors comprise galvanic skin conductance sensors for evaluation of emotional or physical stress. 
         [0093]    8. A system as in any of the previous embodiments, wherein the one or more sensors comprise global positioning sensors to track movement and location within the abdomen. 
         [0094]    9. A system as in any of the previous embodiments: wherein said belt comprises an inner inelastic belt having a first end and a second end configured to overlap with the first end when positioned around the abdomen of the user; wherein the first end and second end comprises an array of capacitance measuring electrodes; and wherein the electrodes are configured to measure displacement of the first end with respect to the second end to measure changes in abdominal circumference over time. 
         [0095]    10. A system as in any of the previous embodiments, further comprising: programming executable on said processor for: acquiring data relating to the signals; generating an acoustic feature set for each of the one or more sensors; inputting the acoustic feature set to a classifier to produce an output computation corresponding to an inference for a subject condition of the abdomen. 
         [0096]    11. A system as in any of the previous embodiments, wherein the acoustic feature set comprises one or more of: amplitude, primary frequency components, time of occurrence of signals and coincidence of signals. 
         [0097]    12. A system as in any of the previous embodiments, wherein the classifier comprises a Bayesian classifier. 
         [0098]    13. A system as in any of the previous embodiments, wherein the classifier is modified according to training data comprising a library of signals obtained from trials on subjects of a known state. 
         [0099]    14. An abdominal monitoring system, comprising: one or more acoustic sensors configured to be positioned adjacent a user&#39;s abdominal wall to receive signals from the abdominal wall; and a processor coupled to the one or more acoustic sensors; programming executable on the processor for: acquiring data relating to the signals; generating an acoustic feature set for each of the one or more sensors; and inputting the acoustic feature set to a classifier to produce an output computation corresponding to an inference for a subject condition of the abdomen. 
         [0100]    15. A system as in any of the previous embodiments, wherein the acoustic sensors comprise digital stethoscopes transducers. 
         [0101]    16. A system as in any of the previous embodiments, wherein the acoustic sensors are configured to receive real-time acoustic signals relating to one or more of: gastrointestinal and abdominal wall functions, motility emanating from the gastrointestinal tract and heart rate via abdominal arterial pulse. 
         [0102]    17. A system as in any of the previous embodiments, wherein the acoustic feature set comprises one or more of: amplitude, primary frequency components, time of occurrence of signals and coincidence of signals. 
         [0103]    18. A system as in any of the previous embodiments, wherein the classifier comprises a Bayesian classifier. 
         [0104]    19. A system as in any of the previous embodiments, wherein the classifier is modified according to training data comprising a library of signals obtained from trials on subjects of a known state. 
         [0105]    20. A system as in any of the previous embodiments, further comprising: a belt configured to be positioned around the waist of the user; wherein the belt is configured to support the one or more acoustic sensors such that the one or more sensors are positioned adjacent the abdominal wall of the user. 
         [0106]    21. A system as in any of the previous embodiments, further comprising: a wireless transceiver coupled to the one or more acoustic sensors for transferring the acquired sensor data to a remote server. 
         [0107]    22. A system as in any of the previous embodiments, wherein the remote server comprises a data fusion module for identification, classification, and notification of abdominal physiological events. 
         [0108]    23. A method for monitoring the abdomen of a patient, comprising: positioning one or more acoustic sensors configured to be positioned adjacent a user&#39;s abdominal wall to receive signals from the abdominal wall; acquiring data relating to the signals; generating an acoustic feature set for each of the one or more sensors; and inputting the acoustic feature set to a classifier to produce an output computation corresponding to an inference for a subject condition of the abdomen. 
         [0109]    24. A method as in any of the previous embodiments, wherein the acoustic sensors comprise digital stethoscopes transducers. 
         [0110]    25. A method as in any of the previous embodiments, wherein the acoustic sensors are configured to receive real-time acoustic signals relating to one or more of: gastrointestinal and abdominal wall functions, motility emanating from the gastrointestinal tract and heart rate via abdominal arterial pulse. 
         [0111]    26. A method as in any of the previous embodiments, wherein the acoustic feature set comprises one or more of: amplitude, primary frequency components, time of occurrence of signals and coincidence of signals. 
         [0112]    27. A method as in any of the previous embodiments, wherein the classifier comprises a Bayesian classifier. 
         [0113]    28. A method as in any of the previous embodiments, wherein the classifier is modified according to training data comprising a library of signals obtained from trials on subjects of a known state. 
         [0114]    29. A method as in any of the previous embodiments, further comprising: transferring the acquired sensor data to a remote server. 
         [0115]    Although the description herein contains many details, these should not be construed as limiting the scope of the disclosure but as merely providing illustrations of some of the presently preferred embodiments. Therefore, it will be appreciated that the scope of the disclosure fully encompasses other embodiments which may become obvious to those skilled in the art. 
         [0116]    In the claims, reference to an element in the singular is not intended to mean “one and only one” unless explicitly so stated, but rather “one or more.” All structural, chemical, and functional equivalents to the elements of the disclosed embodiments that are known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the present claims. Furthermore, no element, component, or method step in the present disclosure is intended to be dedicated to the public regardless of whether the element, component, or method step is explicitly recited in the claims. No claim element herein is to be construed as a “means plus function” element unless the element is expressly recited using the phrase “means for”. No claim element herein is to be construed as a “step plus function” element unless the element is expressly recited using the phrase “step for”. 
         [0000]    
       
         
               
             
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Summary of Key Clinical Indications 
               
             
          
           
               
                   
                 Data 
                 Clinically Relevant 
                   
               
               
                 Condition 
                 Acquired 
                 Classifications 
                 Treatment Protocols of Relevance 
               
               
                   
               
               
                 Postoperative 
                 Acoustics 
                 Stage of intestinal 
                 If evidence of postoperative ileus and poor 
               
               
                 Ileus 
                 Girth 
                 recovery, including 
                 recovery, then no feeding. If no evidence of 
               
               
                   
                   
                 ileus vs. no ileus, and  
                 ileus or signs of recovering ileus, then advance 
               
               
                   
                   
                 ability to accept oral 
                 diet to expedite timely discharge. Provides 
               
               
                   
                   
                 intake vs. not 
                 earlier and more accurate classification of post- 
               
               
                   
                   
                 prepared for oral 
                 operative ileus status. 
               
               
                   
                   
                 intake. 
                   
               
               
                 Bowel 
                 Acoustics 
                 No bowel 
                 If evidence of partial or complete bowel 
               
               
                 obstruction 
                 Girth 
                 obstruction vs. 
                 obstruction, then no feeding, careful 
               
               
                   
                   
                 partial bowel 
                 monitoring, abdominal imaging, and possibly 
               
               
                   
                   
                 obstruction vs. 
                 abdominal surgery on a timely basis. Provides 
               
               
                   
                   
                 complete bowel 
                 earlier identification of bowel obstruction and 
               
               
                   
                   
                 obstruction. 
                 earlier medical and/or surgical intervention. 
               
               
                 Intensive Care 
                 Acoustics 
                 “Acute abdomen” vs. 
                 If evidence of abdominal expansion, 
               
               
                 Status 
                 Girth 
                 “benign abdomen.” 
                 hyperdynamic bowel sounds, or abdominal wall 
               
               
                   
                 EMG 
                 Especially relevant 
                 tension suggesting pain, evaluate for evidence 
               
               
                   
                   
                 among non- 
                 of acute abdominal infection, inflammatory 
               
               
                   
                   
                 communicative 
                 process, or obstruction. Provides earlier 
               
               
                   
                   
                 patients, common in 
                 identification of evolving intra-abdominal 
               
               
                   
                   
                 the ICU. 
                 processes, and trigger earlier diagnosis through 
               
               
                   
                   
                   
                 directed physical exam and/or imaging. 
               
               
                 Ascites 
                 Girth 
                 Static and dynamic 
                 If evidence of worsening ascites evidenced 
               
               
                   
                   
                 status of ascites 
                 through expanding abdominal girth, then increase 
               
               
                   
                   
                 (mild, moderate, 
                 diuretic dose and reduce salt in diet. The system 
               
               
                   
                   
                 severe, worsening vs. 
                 may allow earlier identification of poorly- 
               
               
                   
                   
                 improving). 
                 controlled ascites among outpatients. 
               
               
                 Narcotic 
                 Acoustics 
                 Overdose vs. 
                 If evidence of ileus in setting of narcotics, 
               
               
                 Bowel 
                 Girth 
                 appropriate dose of 
                 reduce dose and titrate to level that maintains 
               
               
                   
                   
                 narcotics. 
                 maximal 24-hour GI acoustics while controlling 
               
               
                   
                   
                   
                 pain. The system may allow more rationale and 
               
               
                   
                   
                   
                 evidence-based dosing of narcotics while 
               
               
                   
                   
                   
                 minimizing resource-intensive GI side effects. 
               
               
                 IBD 
                 Acoustics 
                 Bowel obstruction 
                 If evidence of evolving bowel obstruction in at- 
               
               
                   
                 Girth 
                 from strictures vs. no  
                 risk outpatients, then arrange earlier provider 
               
               
                   
                 EMG 
                 obstruction. 
                 visit and/or abdominal imaging. If evidence of 
               
               
                   
                   
                 Hypermotility and/or 
                 increasing motility and bowel movement 
               
               
                   
                   
                 diarrhea vs. 
                 frequency, then increase medication doses or 
               
               
                   
                   
                 normotility and 
                 start new targeted therapies. Provides more 
               
               
                   
                   
                 normal stool 
                 timely and accurate identification of worsening 
               
               
                   
                   
                 frequency. 
                 clinical status among outpatients with ulcerative 
               
               
                   
                   
                   
                 colitis and Crohn&#39;s. 
               
               
                 Abdominal 
                 Acoustics 
                 Bloating from gas 
                 If evidence of functional bloating, then 
               
               
                 Bloating 
                 Girth 
                 mishandling vs. 
                 behavioral therapy; if evidence of gas 
               
               
                   
                 EMG 
                 functional bloating 
                 mishandling, then antibiotic and dietary 
               
               
                   
                   
                 with abdominal wall 
                 therapy. 
               
               
                   
                   
                 relaxation. 
                   
               
               
                 Diarrhea/Fecal 
                 Acoustics 
                 Anorectal 
                 If evidence of anorectal dysfunction, then 
               
               
                 Incontinence 
                   
                 dysfunction vs. meal 
                 directed therapy for anorectum; if volume, then 
               
               
                   
                   
                 related vs. volume 
                 medical therapies. 
               
               
                   
                   
                 related mechanisms. 
                   
               
               
                 Constipation 
                 Acoustics 
                 Slow vs. normal 
                 If slow transit, then medications to increase 
               
               
                   
                 Girth 
                 transit vs. pelvic 
                 motility. If normal transit, consider centrally 
               
               
                   
                   
                 dyssynergia 
                 acting therapies. If dyssynergia, then behavioral 
               
               
                   
                   
                 mechanisms. 
                 therapies. 
               
               
                 Irritable 
                 Acoustics 
                 Central vs. peripheral 
                 If central, then centrally-acting therapies and 
               
               
                 Bowel 
                 Girth 
                 mechanism of IBS 
                 behavioral modification. If peripheral, then 
               
               
                 Syndrome 
                 EMG 
                 symptoms. 
                 peripheral medical therapies for motility, 
               
               
                 (IBS) 
                 Galvanic 
                   
                 bacteria, etc. Improves monitoring and 
               
               
                   
                   
                   
                 categorizing patients with IBS.