The chronic and relapsing nature of inflammatory bowel disease (IBD) means patients must go to the doctor for ongoing monitoring to predict and prevent flares and check treatment effectiveness. However, these office visits offer only a snapshot of the patient’s disease status.

Now digital technologies, particularly mobile apps, offer the potential to make keeping tabs on IBD easier for patients and physicians alike.

This technology will “hopefully enable us to monitor our patients in a more continuous and passive manner, and in the comfort of their homes, providing us with greater understanding of how they’re feeling, and how their IBD is doing,” Robert Hirten, MD, associate professor of medicine and artificial intelligence and human health at the Icahn School of Medicine at Mount Sinai, New York City, told Medscape Medical News.

Health apps facilitate personalized treatment plans because they increase patients’ involvement in their care and provide clinicians with real-time clinical data, wrote Adam Burton, MD, of the Department of Medicine, Brown University, Providence, Rhode Island, and a colleague in a recent narrative review of the current state of mobile health technology for IBD.

What Apps Are Available?

The review Burton coauthored focused on six IBD apps available in the US that have been clinically studied and validated:

Ayble Health, an app covered by a few insurance plans, is designed for patients with IBD and irritable bowel syndrome (IBS). Users record symptoms and daily dietary intake and an algorithm guides them through a four-phase elimination diet. It also features access to a “Mind-Gut Program” to help patients address mental health concerns. Patients can use the app to connect with a gastrointestinal(GI) healthcare professional, but it doesn’t connect with their own care teams or offer access to providers who can manage medication. A study including patients with IBS and IBS/IBD overlap found that, after 9 weeks, 62.5% of those with ulcerative colitis and 77.8% of those with Crohn’s disease had achieved symptomatic resolution.

• Oshi Health, an app and website, is designed for patients with IBD, IBS, and/or other chronic GI conditions. The program, covered by several major insurance plans, connects patients with GI physicians, dietitians, psychologists, and health coaches. Patients can use the app to track symptoms and communicate with clinicians via secure messaging. They also can access educational materials and incorporate data from wearable fitness trackers. A 9-month prospective trial of > 300 patients with IBD, IBS, or other related GI disorders conducted by Oshi found that 98% of patients reported satisfaction with the program, 89% reported improved quality of life (QoL), and 92% reported symptom improvement.
• MyGIHealth is a cloud-based app developed by My Total Health Inc., researchers, and gastroenterologists. It allows patients to track symptoms and gain deeper understanding of those symptoms by accessing educational materials. The app uses smart logic to “interview” patients and generates a history of present illness (HPI) report to expedite symptom assessment when presented to a gastroenterologist. An independent group of physicians reviewed these HPIs and found them superior to HPIs written by physicians during usual care in GI clinics.
• Trellus Health, an app developed by physician-scientists at the Icahn Mount Sinai School of Medicine, is available through partner organizations such as health plans and employers. The Trellus Elevate program uses a Health Insurance Portability and Accountability Act (HIPAA)-compliant digital platform offering patients with IBD and IBS access to nurse educators, dietitians, and health coaches. Individualized virtual sessions provide support between office visits, and patients have access to tools for resilience management, behavior modification, remote monitoring, and health maintenance. Patients with IBD who used this approach, aimed at increasing patient resilience, showed a reduction in opioid and corticosteroid use and in emergency department (ED) visits compared with patients receiving usual treatment.
• Health/PROMISE, a cloud-based tool developed and only available at Mount Sinai, enables patients to track symptoms and QoL and is integrated with users’ electronic health records (EHRs). Studies found that the app improves users’ QoL scores and reduces the number of ED visits and hospitalizations.
• The UCLA eIBD app, available only to UCLA Health patients, integrates appointment reminders and medication trackers with a healthcare provider portal. It includes a messaging feature, surveys assessing QoL and disease activity, and self-help education modules. A study of this platform found significantly fewer upper endoscopies and less fecal calprotectin testing among app users. There were fewer ED visits, hospitalizations, surgeries, and imaging studies, but the difference did not reach statistical significance. App users also reported high levels of satisfaction.

Each app offers advantages and disadvantages, Burton told Medscape Medical News. “No single one dominates the market at this time, and none provides every feature you’d want in a mobile app for patients with IBD,” he added.

Trellus “warrants a larger-scale study” and may be “worth incorporating into a holistic approach to IBD care,” Burton said.

Oshi Health brings multiple disciplines together under a single umbrella, Burton noted. “I’m not only referring to nutritionists, nurses and physicians but also psychologists. Depression and anxiety can worsen GI symptoms, so the integration of psychologists is very important,” he said.

Joseph Sleiman, MD, a gastroenterologist at the Digestive Disease and Surgery Institute at the Cleveland Clinic Foundation, Cleveland, said “many patients in his IBD practice use the Ayble app, with adoption highest among younger, tech-comfortable patients and those eager to focus on diet and mental health first.” 

Because Ayble doesn’t connect with the patient’s regular care team, it may make it difficult for clinicians to understand what dietary changes have occurred without asking patients to disclose the information, Sleiman said. He relies on the IBD dietician, who is a member of his multidisciplinary team, to transfer information from Ayble to the patient’s EHR.

Oshi, meanwhile, builds “an entire healthcare team within its app — but this might create two teams caring for the patient,” he noted.

Several other apps are on the market, such as My IBD Care and MyGut, Sleiman said. My IBD Care helps patients monitor physical and emotional wellbeing, sleep, stress levels, medications, and appointments and provides education about IBD management. My Gut enables patients to keep track of symptoms and receive education and provides a communication channel between physicians and patients. The We Can’t Wait app meets a targeted IBD need — to locate nearby accessible restrooms.

Other apps are non-IBD-specific, but focus on issues shared between IBD and other conditions (eg, apps that enhance calm and mental health or apps such as mySymptoms Food Diary for journaling food intake, which was found effective in helping patients detect food-symptom and stress-symptom relationships), Sleiman said. 

Wearables and Beyond

Wearable devices also hold promise for helping patients and physicians manage IBD, although they aren’t yet used for clinical monitoring, said Hirten, a gastroenterologist at Mount Sinai’s Susan and Leonard Feinstein Inflammatory Bowel Disease Center.

These devices are passive in that patients wear them, and they automatically provide a great deal of information, so compliance usually remains high, Hirten said. By contrast, apps require patients to input their symptoms, so “it can be challenging to maintain high adherence, and typically there’s a drop-off in persistent engagement,” he said.

His group at Mount Sinai has been studying whether wearables, many of them commercially available, could predict flares or track how patients respond to medications. One study involved 309 patients with IBD who wore an Apple Watch, Fitbit, or Oura Ring and were followed for an average of 6 months. Participants reported daily disease activity, and their devices recorded longitudinal heart rate (HR), resting heart rate (RHR), heart rate variability (HRV), steps, and oxygenation. Inflammatory markers — C-reactive protein (CRP), erythrocyte sedimentation rate, and fecal calprotectin — were collected.

Circadian patterns of HRV differed significantly between periods of inflammatory flare and remission and between symptomatic flare and remission. Participants took fewer daily steps during inflammatory flares. Additionally, HRV, HR, RHR, steps, and oxygenation were significantly altered up to 7 weeks before inflammatory and symptomatic flares.

“These physiological metrics enabled us to identify individuals with inflammation or with symptoms,” Hirten said.

A different study by Hirten and his group used wearables to assess the impact of inflammation and symptoms on sleep in 101 patients with IBD. The wearable devices (Apple Watch, Fitbit, or Oura Ring) collected sleep metrics, patients filled out daily disease activity surveys, and inflammatory markers were collected. Patients were followed for a mean duration of 228.16 nights. Impaired sleep architecture was found to be associated with inflammatory activity, although the presence of symptomatic flares alone didn’t affect sleep quality.

Hirten’s group also is investigating several novel devices. One study evaluated a wearable device (IBD AWARE, EnLiSense CCM) that senses and measures inflammatory and immune system markers present in sweat but historically discernable only through blood or stool tests. Patients with an IBD-related hospital admission and a CRP level > 5 mg/L wore the sweat-sensing device for up to 5 days. TNF-alpha levels were assessed in sweat and also through traditional bloodwork. These patients were compared with those without IBD. Participants with IBD had a mean sweat TNF-alpha level of 2.11pg/mL vs a mean value of 0.19 pg/mL in healthy control individuals (P < .0001) and sweat TNF-alpha levels correlated with serum values.

Another device under investigation can be placed into a patient’s home, where it emits a wave, similar to a Wi-Fi wave, that tracks metrics that could be associated with flares, including sleep stages, respiratory rate and gait speed.

“Analogous to what we’re doing with wearables, this technology offers a fully passive and noninvasive means to potentially monitor people with IBD.” A study of the device (Emerald sensor, Emerald Innovations Inc) found that it could predict disease flares with high accuracy, sometimes up to 25 days sooner than traditional measures.

“The findings of these studies suggest it’s feasible to monitor and predict IBD activity using these novel tools,” Hirten said.

Tips for Gastroenterologists

Sleiman offered practical tips for gastroenterologists seeking to incorporate IBD-monitoring apps or wearables into clinical practice.

“If it’s an integrated tool in your health system/EHR, talk to your department lead to understand all the privacy notices and the extent of exportability of data. Always get explicit patient consent for bringing wearable data into the chart,” he said. “HIPAA privacy regulations don’t automatically cover consumer apps and wearables, so you should ask vendors about HIPAA status, tracking technologies, data sharing, and breach procedures.”

Physicians should “clarify who’s monitoring alerts, especially during nonworking hours,” Sleiman said. “Patients might assume you’re suddenly responsible for everything related to the app, when sometimes there are other technical or specialized teams not directly linked to your practice, who respond to the patient. Have frank conversations with patients about potential chances of miscommunication with such two-team models.”

Lastly, gastroenterologists should look at the impact of these apps on their workflow, Sleiman advised, because digital solutions should enhance clinical care rather than increasing the burden.

“As time goes on and apps get better, the barrier of entry will likely be decreased, and then use of these technologies will be more widely possible, more affordable, and more versatile for varying populations,” Burton said.

Hirten reported receiving consulting fees from Bristol Meyers Squibb and AbbVie, stock options from Salvo Health, and research support from Janssen, Intralytix, EnLiSense, and the Crohn’s and Colitis Foundation. Burton and Sleiman declared no relevant financial relationships. 

Batya Swift Yasgur, MA, LSW, is a freelance writer with a counseling practice in Teaneck, New Jersey. She is a regular contributor to numerous medical publications, including Medscape and WebMD, and is the author of several consumer-oriented health books, as well as Behind the Burqa: Our Lives in Afghanistan and How We Escaped to Freedom (the memoir of two brave Afghan sisters who told her their story).