Wearable Tech Shows Promise for Predicting IBD Flares

DENVER -- A smart watch app may help physicians and patients pinpoint and predict inflammatory bowel disease (IBD) flares, researchers reported.

When a person with IBD has a normal gut environment, a bell curve is produced by the watch application, explained Robert Hirten, MD, of the Icahn School of Medicine/Susan and Leonard Feinstein Inflammatory Bowel Disease Center at Mt. Sinai School of Medicine in New York City.

But if that curve flattens per sweat-based inflammatory markers, IBD flare is possible and "this preliminary analysis of a small percentage of the IBD Forecast Study cohort demonstrates the feasibility of using wearable devices to identify, and...potentially predict, inflammatory bowel disease flares," Hirten said at a poster presentation at the Crohn's and Colitis Congress.

Hirten told MedPage Today that "when people are felling well, they may not be thinking about interacting with their doctor, but we know that sometimes things are changing in the body and there could be a flare coming."

He said that by adding this app to devices such as the Apple Watch and similar devices, which monitor heart rate variability in the background, the patient and doctor can noninvasively keep track of worrisome changes in patients with IBD.

"Advances in wearable technology allow for passive, continuous, and noninvasive assessment of physiological metrics, including heart rate variability [HRV]...We have demonstrated that changes in heart rate variability precedes an inflammatory bowel disease flare, and can predict physiological resilience and identify inflammatory events such as SARS-CoV-2 infection," Hirten and colleagues stated in the poster.

Hirten's group enrolled 125 individuals (average age 34; three-fourths women; 90% white) with IBD, in 29 states, who had an Apple Watch, to which the custom eHive app was uploaded. The patients answered daily health questions. The sweat-sensing device in the study continuously measured C-reactive protein (CRP), tumor necrosis factor (TNF)α, and interleukin-6 (IL-6). "The immunoassay on the sweat sensor was developed by immobilizing a specific capture probe antibody to capture CRP, TNFα and IL-6 in sweat," the authors explained.

HRV metrics -- the mean of the standard deviations of all the NN intervals (SDNN) -- were analyzed using a mixed-effect cosigner model that incorporated BMI, age, and sex. About 60% of the patient were diagnosed with Crohn's disease, while the others had an ulcerative colitis diagnosis.

The mesor ("midline of the circadian pattern of the SDNN") was higher among patients undergoing clinical flare versus those in clinical remission (mean 44.43), while the mesor of the circadian pattern of the SDNN was lower in patients with an inflammatory flare versus patients with normal inflammatory markers (mean 43.04), the authors reported.

"Hopefully, in the next year we will be able to analyze a much larger dataset, and then after that we will actually try to apply this work clinically," Hirten said.

Syed Adeel Hassan, MD, of the University of Kentucky in Lexington, told MedPage Today that "this is early days in using these wearable devices to detect flares in inflammatory bowel disease. It is an exciting concept because the same type of communication has been utilized with patients who have heart failure and use remote cardiac monitoring to keep track of how well they are doing."

Hassan, who was not involved in the research, noted that he would "like to see if there is a system in place where you can track a patient, who you know has pretty bad disease, and is there a way of receiving that data back if there is a disturbance in that kind of activity."

"I think that heart rate variability can be beneficial in the inflammatory bowel disease setting, but you also have a lot of nervousness and anxiety among these patients who have a very bad disease," he stated. "The heart rate variability may be an early warning sign, but I think it is fairly nonspecific. It may be difficult to identify how inflammatory bowel disease affects heart rate variability, because there are a lot of things that can affect heart rate variability, but it is possible."

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