BME.19 An Indicator for Ileostomy Output Enzymes

• Julie Gawenda
• Jennifer Meza
• Rene Sieracki
• Mary Ashley Tenedor
• Waeezah Waqar

Peristomal skin complications (PSCs) are concerning for ileostomy patients due to their high incidence and interference with their quality of life. In an ileostomy procedure, the ileum is diverted to the stoma, an opening in the abdominal wall, which connects to an ileostomy bag. Ileostomy output, known as dejecta, is collected in the ileostomy bag. The relationship between the dejecta and peristomal skin introduces physical and chemical concerns contributing to PSCs’ cyclic presence. The barrier’s integrity is diminished by the cyclic ripping pattern established by the frequent changing of ileostomy bags adhered to peristomal skin. Additionally, differences in pH around the stoma and the presence of enzymatic activity can chemically induce PSCs. Healthy skin, which is slightly acidic, interacts with the slightly alkaline enzymes in dejecta. Upon leakage of the dejecta due to stoma size or body changes, the integrity of the skin barrier is reduced. High throughput characterization of dejecta protease enzymes is needed to allow Hollister Incorporated research and development engineers to predict the onset of PSCs and refine product development that mitigates PSCs. The quantification of proteases is not standard practice; thus, developing a device that can provide this functionality could provide more efficient ostomate care. Current macromolecule detection methods include enzyme-linked immunosorbent assays (ELISAs) and microPAD microfluidic devices. However, these methodologies lack speed and affordable distribution. Thus, our design seeks to enable rapid detection, offer portability, and display specificity to the characteristic proteases found in dejecta. The proposed prototype is monikered the “wax/paper sandwich” and is specific to chymotrypsin detection. The device is composed of four layers of milled wax and chromatography paper that are melted together to direct the dejecta sample downwards through two columns. The protease in the sample will react with a pre-deposited chymotrypsin colorimetric substrate to yield an intensity-based colorimetric quantification of concentration compared to a control. Calibration testing has demonstrated the ability to differentiate between the color intensities of varying chymotrypsin concentrations, thus, yielding a valuable tool for determining protease composition. Future iterations of our device will increase the likeliness of PSC onset prediction, streamline prevention solutions, and lead to a point-of-care device.