Year: 2019
Type: editorial
Abstract: Engineering has contributed to medicine for centuries. Take biomechanics as an example. The first literature using the concept of biomechanics was published by Aristotle (384–322 B.C.) and in “Nei Jing” by anonymous Chinese authors at an even earlier age.1 Century's later, physicists and mechanical engineers inspired work on the circulatory system and on the musculoskeletal system of our body. In a similar manner, electrical engineering made huge contributions primarily in medical instrumentation of research equipment and diagnostic technology. Nowadays, we often use the term bioengineering (short for biological engineering). In broad terms, bioengineering is the discipline of engineering in medicine. According to Merriam-Webster, bioengineering is “the application of engineering principles, practices, and technologies to the fields of medicine and biology especially in solving problems and improving care.” It includes topics such as biomechanics, biomaterials, bioelectronics, drug discovery, genetic engineering, and cell engineering. Bioengineering often use mathematical description of specific processes and physiological events using computer modeling. The bioengineering field was boosted by the work of UCSD Professor Yuan-Cheng Fung,1 often named the Father of Bioengineering. Fung mentored and inspired thousands. Compared to the cardiovascular field and orthopedic surgery, gastroenterology has been relatively slow to embrace the concepts of bioengineering. Modeling studies of GI behavior are very sparse, despite the significant work by James Christensen, Brasseur, and others.2-4 Despite its apparent simple function, the digestive tract exhibits very complex anatomy and neurophysiology. Consequently, modeling is necessary because the true behavior cannot always be measured. The slow acceptance in the GI community may be due to several factors such as the mathematical foundation and communication problems between engineers and physicians who are trained to think in different ways. Typically, physicians think critically in terms of differential diagnoses whereas the engineer's thinking model is in the context of conceptual models. Engineers typically work structure from design to product, which includes many tasks including prototyping, verification and validation testing, quality assurance, risk assessment, and regulatory approval. Important steps from idea to product launch is shown in Figure 1. Bioengineers are trained in understanding biology as well as engineering principles. The dual way of thinking bridges medicine and engineering and is greatly facilitated by interdisciplinary teamwork. How can bioengineering be beneficial in gastroenterology? The short answer is “in almost any way,” because almost all problems in gastroenterology can gain new solutions from interdisciplinary approaches and solutions. We can only treat patients optimally if we reach correct diagnosis through proper testing technology and skills. The basic functions of the GI tract are mechanical and chemical, which are physics and engineering homeland. However, the clinical problems, risk assessment, and implementation of therapy are medical. Many devices and technologies have reached advanced stages nowadays, therapeutic endoscopy, POEM, robotic surgery, and ingestible endoscopic devices, just to name a few. Bioengineering is important in basic science as well as in translational and clinical science. Researchers have spent years using experimental and modeling approaches to understand the biomechanical properties of the GI tract and how these properties remodel in disease.4 Advanced modeling was employed to describe the active and passive mechanical properties in layered GI wall. This mechano-physiological knowledge is now used to develop medical devices for better understanding physiological and pathophysiological mechanisms and diagnosing GI diseases. EndoFLIP and Fecobionics are examples of spin-off devices.4, 5 EndoFLIP provides geometric profiling of GI sphincters and is commercially available. The Fecobionics device, a simulated feces that integrates most of current anorectal functional tests, introduces a new era of defecatory testing based on the bionics concept (https://en.wikipedia.org/wiki/Bionics).5 Another example of a novel experimental device is the multimodal probe developed for studying symptom mechanisms in functional esophageal disorders.6 It stimulates various types of receptors and now has added measurement features (Fig. 2). The above-mentioned devices would likely not have been developed without bioengineers and an interdisciplinary team. However, the road is long from invention, prototype design, product development, validation, and proof-of-concept studies to clinical testing, not least the regulatory approval and commercialization (Fig. 1). Very few ideas and patents actually reach the clinical market and often it will take 10–12 years. Clearly, there is much more to come in this exciting field. The digestive tract constitutes an exciting series of organs along with the liver and pancreas for bioengineering innovations. Ingestible and implantable devices in the digestive system will revolutionize diagnostics and therapy. There are myriads of opportunities for those with innovative minds who can manage successfully to bridge biology and engineering and make the travel from idea to commercialization. Bionics, biomechatronics, in-body telemetry, robotics, stem cell transplantation for treatment of liver and pancreatic disease, deep learning, systems biology, multiscale modeling, and AI are terms and trends that we will meet often in the future. A single person cannot comprehend it all. Interdisciplinary academic teams open to collaboration with other academic groups, industry, and public–private partnerships will be crucial in guiding the roadmap to advancements in gastroenterology.
DOI: 10.1111/jgh.14628
Author: H Gregersen
Institutions: Chinese University of Hong Kong, Prince of Wales Hospital
Language: English
Subfield: Information Systems and Management
Field: Decision Sciences
Domain: Social Sciences
Open Access status: bronze
OpenAlex ID: W2920649709