# Bioelectrical Signals for the Diagnosis and Therapy of Functional Gastrointestinal Disorders
## 6 Summary and Future Directions  
Since [PERSON]'s first electrical recordings of the GI tract almost 100 years ago, the bioelectrical signatures of the GI organs have been extensively studied and identified [58]. However, there remains much to explore in the pursuit of bioelectrically based diagnostic tools and therapies for FGIDs. Advances in high-resolution mapping techniques in the last three decades have provided deeper insights into the GI electrophysiology and pathophysiology [145]. Existing research shows a clear relation between certain FGIDs and impaired bioelectrical activity (see summary in Table 1). In parallel, the discovery of ICC and their function in GI motility has helped to identify the underlying factors of certain FGIDs and has become a major research focus [67]. Such advances and findings in the GI electrophysiology have shown that assessment of bioelectrical activities could potentially help to identify the diverse etiologies of FGIDs and overcome the drawbacks of the current clinically adapted methods, which mostly target symptoms and are often unreliable and exclusionary. However, the lack of more accurate and reliable but less invasive methods remains a significant challenge for clinical translation of bioelectrical assessment of the GI tract. Similarly, electroceuticals have also gained significant interest from researchers (see summary in Table 2). Recently, the National Institutes of Health have initiated an ambitious research program entitled the Stimulating Peripheral Activity to Relieve Conditions (SPARC, [[https://sparc.science/](https://sparc.science/)]([https://sparc.science/](https://sparc.science/))) to transform  
\begin{table}
\begin{tabular}{l l l l} \hline \hline
**Technique** & **Organs** & **Advantages** & **Limitations** \\ \hline Low-resolution & Stomach [58; 59; 60] & High SNR & Invasive \\ serosal recordings & Small intestine [103; 104] & Suitable for long term & No spatial information \\  & Colon [122; 124; 125; 134] & recordings & \\ \hline High-resolution & Stomach [63; 64; 65; 66] & High SNR & Invasive \\ serosal recordings & Small intestine [105] & Spatial information & Expensive equipment \\ \hline Laparoscopic serosal & Stomach [69; 70; 71] & High SNR & Limited coverage \\ recordings & Small intestine [69] & Reduced invasiveness & Limited coverage \\ \hline Mucosal/intraluminal & Stomach [72; 73; 74] & & \\  & Small intestine [106; 107] & Minimally invasive & Low SNR \\  & Colon [122; 125; 128; 129; 130; 131; 132; 133] & & \\ \hline  & Oropharynx and Esophagus (sEMG & Non-invasive & \\  & [25; 26], EEG [29; 30; 31; 320; 321; 322; 323; 324; 325; 326; 327; 328; 329; 330; 331; 332; 333; 334; 335; 336; 337; 338; 339; 340; 341; 342; 343; 344; 345; 346; 347; 348; 349; 350;  
our understanding of nerve-organ interactions with the intent of advancing bioelectronic medicine. Studies have reported promising outcomes in terms of improvement of the symptoms of FGIDs, suggesting that electroceuticals which directly target the underlying conditions could potentially be an effective therapy in the treatment of FGIDs, and replace the limited existing conventional methods [14]. However, more reliable, long-term and randomized human clinical trials targeting all GI organs are needed to prove the efficacy of electrical therapies, as there is insufficient evidence of efficacy from the limited number of human studies. In order to advance clinical translation of bio-electrical methods of investigation and therapeutics for FGIDs, there needs to be a concerted effort to transition from treating the symptoms to addressing the underlying causes. Moreover, a closed-loop stimulation or pacing system that is operated by the inputs from the different mechanisms modulating the gut motility could potentially increase the efficacy of bioelectrically based therapies. However, such system requires the ability of performing long-term recordings and developing sophisticated real-time analytical methods.