The research of Adil E. Bharucha, MBBS, M.D., is driven by a desire to do better for patients, whose symptoms and insights provide the impetus for his research. It is focused around four major themes: anorectal and pelvic floor disorders as manifested in obstructed defecation and fecal incontinence, colonic motor dysfunction and chronic constipation, diabetes-related diseases of the intestinal tract (diabetic gastroenteropathy), and functional dyspepsia. Another emerging theme is to better understand the epidemiology and pathophysiology of diverticulosis and its complications. These conditions are common, cause considerable distress and are poorly understood; diagnostic tests and treatments are suboptimal or not widely available.
Dr. Bharucha's research investigates the epidemiology, pathophysiology and management of anorectal and pelvic floor disorders. These studies include extensive community-based studies to describe the prevalence of these conditions, severity of symptoms and their impact on quality of life. Dr. Bharucha has developed instruments to evaluate symptom severity, shown that bowel disturbances are the most important risk factors for fecal incontinence, developed novel approaches for assessing anorectal functions, and identified previously unrecognized associations between symptoms and anorectal dysfunctions.
He is also evaluating new pharmacological treatments. These studies utilize a variety of techniques to evaluate, in a refined manner, the anorectal functions that maintain control of stool (continence). He has also collaborated with Joel G. Fletcher, M.D., and Stephen J. Riederer, Ph.D., to adapt existing MRI sequences to visualize pelvic floor motion in real time, a technique that was introduced into clinical practice at Mayo Clinic and is now widely used. Together with Joel P. Felmlee, Ph.D., and Richard L. Ehman, M.D., he is developing magnetic resonance elastography to investigate the mechanical properties of the anal sphincter.
In his research on diabetic gastroenteropathy, Dr. Bharucha collaborates with Michael Camilleri, M.D., Phillip A. Low, M.D., Armando Manduca, Ph.D., and Alan R. Zinsmeister, Ph.D., to better understand the mechanisms and management of diabetes-related gastrointestinal symptoms. Their work has recently focused on the contribution of gastric emptying disturbances to glycemic control. In addition, while most attention has focused on the stomach, Dr. Bharucha's ongoing studies suggest that increased small intestinal sensitivity to nutrients may contribute to symptoms in functional dyspepsia and diabetes. Dr. Bharucha also conducts studies in humans of promising agents of diabetic gastroenteropathy identified in mice models by Gianrico Farrugia, M.D., and Tamas Ordog, M.D.
Additionally, Dr. Bharucha is a co-investigator on Dr. Camilleri's National Institutes of Health (NIH)-funded project to investigate the relationship between bile acids, colonic functions and gene interaction in irritable bowel syndrome.
- Fecal incontinence. In cooperation with Mayo Clinic's Women's Health Center and the Center for Advanced Imaging Research, Dr. Bharucha focuses on the validation of instruments to measure symptoms of fecal incontinence, investigates risk factors and causes, and develops novel ways to asses and manage it.
- Defecatory disorders resulting in constipation. Dr. Bharucha and colleagues work toward optimized therapy for this common condition, which requires accurate diagnosis and individualized treatment. They have characterized several different phenotypes of the disorder, developed a novel device to assess anal pressures, and proposed an alternative symptom-based practical classification of chronic constipation that has been confirmed by other studies.
- Diabetic gastroenteropathy. Among other advances, studies led by Dr. Bharucha have identified a drug that is effective for treating constipation in people with diabetes and are now evaluating the relationship between blood glucose control and gastric emptying in diabetes. This research encompasses not only the more commonly investigated condition of delayed gastric emptying, but also looks at rapid gastric emptying in patients with diabetes.
- Colonic diverticulitis. Our current understanding of the epidemiology of diverticulitis is almost exclusively derived from hospital-based databases. However, most patients with diverticulitis are treated as outpatients. Hence, Dr. Bharucha and colleagues are studying the epidemiology of colonic diverticulitis (for example, its frequency, complications and recurrence rate) in the community.
Significance to patient care
Dr. Bharucha's research is driven by the desire to understand mechanisms of disease and develop new therapeutic approaches for patients. Procedures and techniques resulting from his research have already been standardized and incorporated into patient care. For example, he coordinated the introduction of colonic and rectal motility studies into clinical practice using methods derived from his research program.
Pyridostigmine, a widely available drug, was demonstrated to be efficacious for people with diabetes who had chronic constipation. Clonidine improved symptoms in patients with diarrhea and fecal incontinence. An ongoing study is evaluating the effects of a new medication for patients with pelvic floor dysfunction and constipation. Dr. Bharucha's goal is to continue to discover innovative ways to improve patients' outcomes and quality of life.
- Co-chair (2002-2004) and chair (2012-2015), Rome III Subcommittee on Functional Anorectal Disorders, the Rome Foundation
- Fellow, American Gastroenterological Association, 2011-present
- Editorial board, Neurogastroenterology & Motility journal, 2009-present; American Journal of Gastroenterology, 2005-2009
- Chair, education committee (2010-2012) and clinical practice committee (2012-2014), American Neurogastroenterology and Motility Society
- Permanent member, Clinical, Integrative and Molecular Gastroenterology Study Section, NIH, 2011-2014
- Janssen Award for Clinical Research in Digestive Sciences, 2005
- Junior Investigator in Clinical Science award, International Foundation for Functional Gastrointestinal Disorders, 2003