Using Tech to Predict IBD Flare-ups

Wearable devices could be the future for monitoring IBD

One of the more difficult parts of living with an inflammatory bowel disease (IBD) such as Crohn’s disease, ulcerative colitis, or indeterminate colitis is not knowing when the disease will become active again. IBD is a condition that goes through periods where the disease is more active and less active. For people who live with a type of IBD, it’s not always known what can cause the disease to become active again and produce signs and symptoms. Wearable monitoring devices may be an answer to this problem.

Woman wearing a fitness tracker

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Monitoring IBD

People with IBD are usually under the care of a gastroenterologist, a physician who specializes in the management of diseases and conditions of the digestive tract. For gastroenterologists, part of managing IBD includes the careful monitoring for the return of signs and symptoms. It’s not an easy thing to do, and there’s no one particular way in which this is done in every patient.

There are tests that physicians will use to try to keep an eye on disease activity and to try to predict when IBD might be flaring up again. Some of them are less invasive because they test blood or stool, but others include tests like colonoscopy, which requires prep and time investment, not to mention the cost. Getting an idea that inflammation in the digestive tract might be starting up or worsening can help in getting the disease under control quicker. This is why researchers have started looking into wearable monitoring devices to predict or track disease activity in people who have IBD.

Wearable Devices

Wearable technology is a device that’s worn somewhere on the body. These devices have sensors on them that measure a bunch of different things, which can include sleep, heart rate, and daily steps or other activities (like cycling or swimming).

Wearable devices can come in a variety of forms (including clothing, glasses, and jewelry) but the one that most people are probably familiar with are fitness bands or watches. These devices have been commercially available for some years and have become fairly common. Worn on the wrist, these are most often used as activity/sleep/heart-rate trackers but in recent years their use has expanded. Watches can now not only measure how many steps a person takes, but can also be paired with smart devices to deliver text messages, make phone calls, or change the channel on the TV, among other things.

Wearable Tech and IBD

The IBDs are complex diseases and monitoring disease activity in order to predict or catch flare-ups takes considerable time, effort, and expertise. A few of the challenges of current monitoring techniques is that they take time, money, and a certain amount of action on the part of the patient. This has spurred researchers to start thinking about what kinds of “passive” monitoring can be done in order to try to get a better idea of when IBD may be becoming active again.

That’s where wearable devices come into play. What if wearable tech could be used to determine if the disease process has changed? While wearable technology comes at all different price points, for the most part, they are considered low cost when compared with other monitoring techniques. Think of the price difference between even the most top-of-the-line Apple Watch and a colonoscopy. Plus, they can be used for a long period of time. Monitoring tests on blood or stool are a snapshot in time, and while they are critically important to the good management of IBD, they do have certain limitations.

An activity tracker or wearable device can track the heart rate, daily steps, and sleep pattern of a patient over a long period of time. This gives researchers a huge amount of data that can then be sliced and diced in a number of ways. Because this is considered “passive” participation, it’s thought that this will be easier on patients for a few different reasons.

Many patients are already using wearable technology on their own because they want to track things like daily activity or sleep patterns. People also tend to use their wearable devices fairly consistently, especially when it comes to tracking daily activity. Some wearable tech comes with apps or programs that are social in nature and sharing daily activity with friends or a community helps with accountability and might spur some people to stick to their health goals.

In terms of IBD, it’s thought that the metrics coming from a wearable device might be mappable to disease activity. For instance, there's one hypothesis that when IBD-related inflammation is starting, heart rate might speed up. If, for instance, scientists can take all that data from wearable devices and then compare it against the results of the other tests that are already being used to monitor IBD, maybe it will show some interesting conclusions. In this way, there could be another tool in the kit for patients and physicians to use in monitoring IBD.

What the Research Shows

In one study on wearable tech and IBD, the outcomes from 39 patients who were given a FitBit activity tracker and access to a smartphone app to record data were analyzed. These patients, who were diagnosed with ulcerative colitis, had baseline fecal calprotectin and C-reactive protein levels taken before starting in the study.

Fecal calprotectin and C-reactive protein are called biomarkers and they are used in monitoring IBD disease activity. Fecal calprotectin is a test done to measure the amount of calprotectin in the stool. Calprotectin is a type of protein found in stool that may increase when there is intestinal inflammation. A C-reactive protein level is measured with a blood test. When there is inflammation in the body, the levels of C-reactive protein in the blood may increase.

Patients also had their disease activity measured using one of two indices that are often used in IBD research called the Simple Clinical Colitis Activity Index or the Harvey–Bradshaw Index.

Patients used the FitBit and the app for a median of 296 days. The data from the devices were analyzed to see if there was any connection to changes in the patient’s fecal calprotectin or C-reactive protein levels, which were also measured. What the scientists found was that daily resting heart rate actually didn’t correspond to changes in biomarker levels. However, a connection was found between elevated biomarker results, meaning an increase in either the fecal calprotectin or C-reactive protein levels, and daily steps. It was discovered that study participants took fewer daily steps in the week before there was a change in their biomarker results.

Researchers found people with IBD decreased physical activity before a flare-up of symptoms. This and other passively-collected data might one day be used to predict flare-ups.

Wearable Tech in the Future

Monitoring IBD through passive means and remote monitoring is an idea that’s starting to take hold. This study included a small number of patients but given that there were some findings that show promise, it will hopefully lead to larger studies.

Daily activity might not be the only thing that changes when a flare-up is starting, so there could be other data that’s tracked by wearable tech or smart devices which might give a broader picture of IBD activity. There is a focus on passive monitoring because it’s easy for patients to do: charging and wearing the device on a daily basis is pretty much all that’s needed. Patients might be motivated, however, to participate in other types of remote monitoring, even if it requires some effort on their part. Remote monitoring techniques might be more attractive to some patients than invasive or potentially more costly testing.

In addition, people living with IBD often have other conditions that affect more than the digestive tract. People with IBD often cope with sleep disturbances, fatigue, and joint pains, to name a few. There’s a potential for wearable devices to be useful in predicting or monitoring some of the many conditions that tend to be clustered with IBD. It’s not too difficult to envision a future where a person’s overall health is monitored and managed partly with wearable devices and/or remote monitoring. 

A Word From Verywell

The future of wearable tech in health care is an exciting field that’s evolving quickly. Cutting-edge technology might be able to give more choices to patients and providers when it comes to managing IBD or other chronic conditions.

One of the biggest open questions for patients, however, is concerns over privacy. Keeping health data from wearable devices restricted to only those who need to see it is an open question. Wearable tech, associated apps, and remote monitoring technology are all potential points of failure because they can be hacked or subject to viruses and malware. This is an aspect of wearables that’s well known and is being addressed in various ways but there will need to be significant efforts made to ensure patient security.

Wearable tech is more commonplace for the management of other chronic conditions than it is for IBD but it’s a good bet that more integration will be coming in the future to gastroenterology. 

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  2. Sossenheimer PH, Yvellez OV, Andersen Jr M, et al. Wearable devices can predict disease activity in inflammatory bowel disease patientsJ Crohns Colitis. 2019;13(1):S404. doi:10.1093/ecco-jcc/jjy222.703

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