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Wearable devices show growing potential in IBD care

"The use of wearables envisions a future where the assessment of disease activity would be ongoing, continuous, and free of clinical visits."

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Wearable health technologies — including consumer fitness trackers, experimental biosensor patches, and virtual reality (VR) headsets — are being explored as new tools to monitor disease activity and support patients with inflammatory bowel disease (IBD).
 
Investigators evaluated 37 studies to assess the impact of the devices on Crohn's disease and ulcerative colitis, in a scoping review published in Clinical Gastroenterology and Hepatology.
 
"The use of wearables envisions a future where the assessment of disease activity would be ongoing, continuous, and free of clinical visits," lead author Vishal Sharma told GI & Hepatology News. "The idea is to pick up flares early, even before the clinical symptoms develop. This review finds that there is literature suggesting that this approach is feasible and may provide a convenient way to monitor disease activity in the future," said Dr. Sharma, of the Department of Gastroenterology at the Postgraduate Institute of Medical Education and Research, Chandigarh, India.
 
Most of the available data reviewed came from wrist-worn fitness trackers and smartwatches, such as Fitbit devices, Apple Watch, and the Oura Ring. Across multiple studies, these devices consistently showed lower physical activity and step counts in patients with active IBD compared with those in remission or healthy controls. Activity levels often improved as patients entered remission or responded to therapy. Several studies also linked moderate-to-vigorous physical activity, measured by trackers, with better bone density, muscle strength, and patient-reported outcomes.
 
Sleep metrics captured by wearables were another recurring theme. Patients with active disease tended to have poorer sleep efficiency and more disrupted sleep, even when total sleep time was longer. Poor sleep quality was associated with higher disease activity and worse quality of life, reinforcing sleep disturbance as an under-recognized burden of IBD.
 
Beyond activity and sleep, some studies focused on heart rate and heart rate variability (HRV), measured using consumer devices such as Apple Watch and Fitbit. Changes in HRV and resting heart rate were observed during symptomatic flares and, in some longitudinal studies, even weeks before flares became clinically apparent.
 
Several studies examined wearable sweat-sensing patches designed to measure inflammatory biomarkers noninvasively. Devices such as IBD Aware and SWEATSENSOR were able to detect C-reactive protein, calprotectin, and cytokines including tumor necrosis factor–α, with moderate to strong correlations to serum levels in small studies. Sweat calprotectin levels tended to be higher in active disease and lower during remission. According to the authors, these devices are still in early development and are largely studied in hospital or research settings, but they represent a promising step toward real-time inflammatory monitoring without blood draws or stool tests.
 
Other emerging technologies included a smart T-shirt embedded with sensors to capture bowel sounds and VR headsets used for symptom and stress management. In pediatric and adult populations, VR-based interventions reduced anxiety and pain during infusions and promoted relaxation. These findings suggest a role for wearables beyond physiologic monitoring, particularly in addressing the psychological burden of IBD, noted investigators.

Patients in the reviewed studies generally reported positive attitudes toward wearable technologies, especially wrist-worn devices. However, the authors noted that most studies were small, heterogeneous, and exploratory.
 
“Some of the findings are probably ready for clinical application, [such as] the finding that use of virtual reality-based interventions seem to alleviate the anxiety associated with infusions,” Dr. Sharma said. “Other findings like the use of wearables to pre-empt the clinical flares probably would need validation in clinical trials. This is also time for clinical trial organizations to consider use of these wearable based tools for monitoring patients included in clinical trials. Such longitudinal data, if confirmatory, will enable a sea change in the way IBD disease monitoring is performed.”
 
He underscored the importance of finding “a common ground between the need for continuous monitoring, clinical decisions, and ethical concerns including concerns about data privacy.” 
 
The authors reported having no relevant disclosures.
 

Invited Commentary

 
GI & Hepatology News invited Sumant Inamdar, MD, MPH, an interventional gastroenterologist in the Division of Gastroenterology and Hepatology University of Arkansas for Medical Sciences, Little Rock, to comment on the study.
 
Why is this study important?
 
Dr. Inamdar: This study is important because it highlights wearable technology as a potential shift in how we manage inflammatory bowel disease. Presently, IBD care is episodic and based on clinical assessments that capture a single moment in time. Use of wearables could make it more continuous with patient-centered monitoring in real-world settings. In routine practice, clinicians often rely on symptoms, labs, and imaging obtained weeks or months apart, which can miss early physiologic changes that precede a clinical flare. Wearable devices offer the opportunity to passively and objectively track parameters such as physical activity, sleep patterns, heart rate variability, and inflammatory signals over time, providing a more dynamic view of disease activity.
 
By integrating these real-time data streams with traditional biomarkers and patient-reported outcomes, wearable technologies may help identify subtle changes before patients become overtly symptomatic. This has the potential to enable earlier clinical intervention, reduce unplanned hospitalizations or steroid use, and support more proactive, personalized disease management.
 
What are the potential clinical implications of the research?
 
Dr. Inamdar: From a clinical perspective, wearable technologies have the potential to add a new layer of data and information into disease activity that is often missed between clinic visits. Early changes in activity, sleep, or heart rate variability may signal worsening disease before symptoms emerge, enabling earlier follow-up or targeted evaluation rather than reactive care. This type of passive, longitudinal monitoring aligns well with how IBD fluctuates over time and may help clinicians intervene earlier in the disease course.
 
To make these technologies acceptable, the validation of noninvasive wearable biomarkers, like sweat-based measures of CRP or calprotectin, is essential. This could further transform care by enabling remote disease monitoring and more individualized treatment adjustments. For patients, this could mean fewer urgent visits, reduced reliance on invasive testing, and a greater sense of control over their disease.
 
What additional research may be needed, and what questions remain unanswered?
 
Dr. Inamdar: The existing literature demonstrates promising associations between wearable-derived metrics and disease activity, but several critical questions must be addressed before these tools can be meaningfully integrated into routine IBD care. Firstly, large, longitudinal studies are needed to validate wearable signals such as changes in physical activity, sleep, heart rate variability, or sweat-based inflammatory markers, against established clinical outcomes, including endoscopic activity, fecal calprotectin, CRP, and validated disease activity indices. Without this correlation, it remains unclear which wearable signals are truly disease-specific versus which are reflective of nonspecific stress, infection, or comorbid conditions.
 
Beyond the science, questions remain about how wearable technologies can be effectively implemented in real-world clinical settings. Long-term patient adherence, device fatigue, and usability remain concerns, particularly during periods of clinical remission when perceived benefit may be low. Integration of wearable data into electronic health records and clinical workflows must be seamless and actionable to avoid data overload for clinicians.
 
Dr. Inamdar reported having no financial disclosures.

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