Mobile health technologies in inflammatory bowel disease: a narrative review

Abstract

Care for patients with inflammatory bowel disease (IBD) has traditionally relied on in-person visits for disease management. However, technological advances have paved the way for innovation in healthcare delivery in the IBD space, most notably through mobile health applications (apps). These apps have many capabilities including, but not limited to, helping patients track symptoms and food intake, communicating with medical providers, connecting with nutritionists, providing access to mental health resources, and providing education about IBD. Given the ubiquity of smartphones and increasing prevalence of technology involvement in healthcare, there is a plethora of apps available for personal and professional use in IBD care. We reviewed and compared some of the most studied and popular apps available on the marketplace to help clinicians understand the state of mobile technologies for IBD and see the potential value of integrating apps in the traditional IBD care model. Furthermore, we review the current state of wearable technology and explore next steps in technology development to further augment care for patients with IBD. IBD is a lifelong disease, without a cure, and a multidisciplinary management approach is critical. Health apps offer unique opportunities for an integrated management strategy, empowering patients to have more involvement in their care, and providing clinicians with real-time clinical data to tailor more personalized treatment plans.

Introduction

Inflammatory bowel disease (IBD), comprised of Crohn’s Disease (CD) and ulcerative colitis (UC), is a chronic disease of the gastrointestinal (GI) system characterized by repetitive episodes of inflammation of the GI tract due to abnormal immune response to gut flora in a genetically sensitive individual. It is estimated that by 2030, over 7 million people will be affected in Europe and North America [1], and there is a significantly increasing prevalence in newly industrialized countries in South America and Asia [2]. Due to the relapsing and remitting nature of IBD, patients often suffer from recurrent medical complications such as refractory inflammation, abscesses, fistulas, strictures, obstruction, perforation, and malabsorption. These complications often require hospitalizations and surgeries, causing financial strain for patients and the healthcare system alike [3–5]. IBD is also linked with psychological comorbidities such as anxiety and depression, adversely affecting quality of life (QoL) and social functioning [6].

IBD is thought to be caused by immune dysregulation and impacted by genetic, microbial, and environmental factors, particularly diet [7]. Dysbiosis is broadly defined as a change to the composition in host gut microbiota, which current murine models suggest is through a combination of loss of beneficial microbiota, growth of pathologic microbiota, and loss of microbiota diversity [8]. Currently, it seems there is a bidirectional relationship between progression of IBD and dysbiosis, although it is unclear which process manifests first [9, 10]. The gut microbiota composition can be greatly influenced by diet [11, 12]. For this reason, there has been a growing emphasis in the IBD community on dietary modifications for symptom management, although diet has not directly been implicated in IBD pathogenesis or intestinal inflammation [13, 14].

IBD care has traditionally relied on face-to-face office visits for disease management, but due to the chronic and relapsing nature of the disease, consistent monitoring is required. Digital innovation in the healthcare space has created opportunities for alternative methods of patient-physician interaction, which was accelerated during the COVID-19 pandemic, and is especially evident for IBD [15–17]. This has paved the way for mobile health technologies to transform IBD care, extending care with providers and shifting more care into patients’ hands.

One example of this is remote health monitoring through mobile health applications (apps). The scope of these apps includes tracking symptoms, logging dietary habits, communicating with providers, connecting patients with nutritionists and mental health professionals, and/or providing educational materials for patients with IBD. With the rise in prevalence of these apps in the digital marketplace, there is a need to discern what apps are available currently and the data supporting their use. This review aimed to explore the current marketplace of mobile health apps for patients with IBD. Furthermore, we briefly explored other methods of remote health monitoring, including wearable devices, and the implications for future care in IBD.

Methods

A literature review was conducted using PubMed for all articles and trials with the following search terms: (“mobile health” OR “digital health” OR “mobile app” OR “smartphone app” OR “digital health” OR “smart watch” OR “ehealth” OR “remote monitoring” OR “wearables”) AND (“IBD” OR “Inflammatory Bowel Disease” OR “Crohn’s Disease” OR “CD” OR “UC” OR “Ulcerative Colitis”). This initial search performed on July 25, 2024, yielded 691 hits, all of which were reviewed. Articles were only included in this review if they specifically studied the use of a mobile health app, wearable device, or specific digital health tool in IBD.

Given the non-exhaustive scope of this paper, we decided to not review all apps available in the app stores and instead focus on the mobile health apps that have been clinically studied. Previous review articles have searched the Apple iOS App Store and Google Play Store for apps related to IBD [18–20].

Results

Web applications

Prior to the widespread use of mobile apps, comprehensive multidisciplinary IBD care models started with web-based and telephone-based models. In this section, we briefly review Constant Care, UC HAT, and Tele-IBD, all of which uniquely impacted the IBD care space.

Constant Care is a web-based platform developed in Denmark in 2009 and was one of the first remote management platforms for patients with IBD. They created a novel index called ‘Inflammatory Burden’ based on simple symptom scores and fecal calprotectin (point of care test done at home with results uploaded to the web application). Inflammatory Burden and well-being survey results are presented to patients and their healthcare providers, which can then be used to adjust medications if necessary. One study followed 333 patients with mild to moderate UC over 12 months and found that 88% of patients using Constant Care preferred it over conventional care, with significantly decreased outpatient clinic visits [21]. However, there was no difference in relapse rates, hospitalizations, surgeries, or adverse events between groups. One study utilized Constant Care to adjust dosing of mesalamine in UC patients based on the Inflammatory Burden, which found a significant improvement in QoL, treatment adherence, and cost reduction when using the platform [22]. Another study used Constant Care to adjust Infliximab dosing for CD patients based on Inflammatory Burden scores; patients using Constant Care had a reduced number of infusions, however, no difference was noted in steroid use, hospitalizations, or surgeries between treatment group and placebo [23]. Unfortunately, Constant Care is currently only available in Denmark. Also, it requires a point-of-care fecal calprotectin testing system and dedicated healthcare support staff, which may limit its broad use.

The home automated telemanagement in UC (UC HAT) system was a web and telephone-based platform developed by the University of Maryland which provided educational information and instructed patients to answer questions about their weight, disease activity, therapy adherence, etc. The system comprised of a netbook computer connected to an electronic scale, which patients would use to weigh themselves and answer questionnaires. This home unit then transmitted results electronically to the patient’s provider. Providers could then review the data and send patients updated action plans on the provided unit. A randomized controlled trial (RCT) found no significant differences in disease activity, medication adherence, or QoL between those using UC HAT and those using conventional care models [24]. The team that developed UC HAT then expanded on the platform for the TELE-IBD trial. TELE-IBD used text messaging to get patient feedback regarding their symptoms and QoL, with a website that offered decision support for the providers. Using this data, providers could alter medications, individualize patient alerts, and create action plans. TELE-IBD also incorporated an educational curriculum delivered via text messages. Overall, disease activity and QoL were not significantly different between the TELE-IBD users and controls. Patients using TELE-IBD most frequently (weekly) did experience a significant decrease in IBD-related hospitalizations (9.8 per 100 participants yearly in the weekly TELE-IBD group vs. 24.1 in the control group), but there was also an increase in telephone encounters and non-invasive testing in this group. Attrition rates were highest in the group receiving the most frequent interaction with UC-HAT, but there was a relative decrease in attrition rates with frequent users in the TELE-IBD trial compared with those in the UC-HAT trial, showing that the text message-based program may be easier for patients to participate in than a strictly web-based program [25]. Neither UC-HAT nor Tele-IBD are commercially available for use by patients at this time.

Personal mobile applications

The widespread ownership of smartphones has led to rapid development of mobile health apps [26]. In this section, we discuss mobile apps targeted toward IBD patients that have been clinically studied and validated. These include apps both created by academic researchers and in the private sector. The major features of these apps are listed in Table 1.

Table 1.

List of mobile apps for IBD management and their target disease population, features, and availability to patients

Application	Target Disease Population	Features	Availability
HealthPROMISE(27)	IBD	Symptom tracking surveys, connect with medical team	Only available through Mount Sinai Health System
UCLA eIBD (28)	IBD	Symptom tracking surveys, medication tracking, connect with medical team, education modules	Only available through UCLA Health System
TECCU(29)	Moderate to Severe IBD	Symptom tracking surveys, connect with medical team	Only available in Spain
myIBDcoach(30)	IBD	Symptom tracking surveys, connect with medical team, education modules	Only available in the Netherlands
Ayble Health(31)	IBS, IBD	AI-assisted dietary modifications, trigger avoidance, mental health	Commercially available (paid)
Oshi Health(32)	IBD, IBS, other chronic GI conditions	Symptom tracking, connect with medical team, integrate with wearables, education modules	Covered through health insurance or commercially available (paid)
My GI Health(33)	IBD, IBS, other chronic GI conditions	Symptom tracking, education modules, “HPI” that can assist providers, connect with healthcare professionals	Commercially available (free)
Trellus Health(34)	IBD, IBS	Mental health, behavior modification, connect with medical team and health coaches	Covered through health insurance

HealthPROMISE is a cloud-based tool developed by the Sinai AppLab at Icahn School of Medicine at Mount Sinai, where patients track symptoms and QoL every two weeks. Data is logged into patient electronic health records for providers to better optimize patient care. Their study had 320 participants, 162 in the group using HealthPROMISE and others in a control group using paper-based logs [27]. Overall, the majority (approximately 3/4) of patients continued to log in to the app every two weeks at the 1-year mark. QoL scores significantly improved among patients using HealthPROMISE. Quality of care (QoC, based on American Gastroenterological Association’s Quality of care indicator checklist) [28] improved continuously over the study period of 575 ± 131 days, with HealthPROMISE users meeting 84% of QoC indicators compared with 65% in the control group [29]. Patients using HealthPROMISE also had a significant reduction in ED visits and hospitalizations in the year of use (3% of patients) compared to the prior year (25% of patients) [30]. HealthPROMISE has demonstrated favorable efficacy, although at this time it is only available within the Mount Sinai Health System. Multisite and controlled studies would be useful to assess its efficacy at a larger scale.

UCLA eIBD is an app that was developed as part of a value-based healthcare program for IBD patients at UCLA that integrated appointment reminders, medication trackers, etc. with a healthcare provider portal. This included a messaging feature to streamline patient care, surveys to assess QoL and disease activity, and self-help education modules. UCLA’s initial study enrolled 60 IBD patients, matched to 177 controls, and found that in the group using UCLA eIBD, there were significantly fewer upper endoscopies performed (−74%, p = 0.012) and less fecal calprotectin testing (−74%, p = 0.015). There were also fewer ED visits, hospitalizations, surgeries, and imaging studies performed, but these did not reach statistical significance [31]. When surveyed, 68% of patients using UCLA eIBD were greatly satisfied with the ease of patient-provider communication within the app, 54% reported improved perception of disease control and QoL, and 79% would recommend the app to others [32]. Similar to HealthPROMISE, UCLA eIBD is only available for use within the UCLA Health network and it would benefit from larger, controlled trials to study clinical benefit.

Telemonitoring of Crohn’s Disease and Ulcerative Colitis (TECCU) is a web-based tele-management system created by a research group in Spain for remote monitoring of patients with moderate to severe IBD or for those who initiate treatment with steroids, immunosuppressants, or biologics. Patients connect to the platform using a computer or mobile phone app. Patients complete surveys about their IBD symptoms and possible adverse events via text message, and the team makes individualized alerts and action plans based on patient responses. The group performed a 3-arm randomized controlled trial (RCT); patients were randomized to groups receiving remote monitoring via TECCU, nurse-assisted telephone care, or standard of care (n = 21 for each group). The group using TECCU had higher rates of remission (based on Harvey-Bradshaw, Mayo, and Walmsley indices), improvement in disease activity (based on fecal calprotectin), and lower number of outpatient visits after 24 weeks (72 visits in TECCU group vs. 85 visits in nurse-assisted telephone group vs. 131 visits in standard-of-care group) [33]. Surveyed patients touted the platform’s usability, educational resources, and continuous and personalized feedback [34]. A larger multicenter trial was performed in 29 IBD centers in Spain, where they found TECCU non-inferior to standard of care to maintain clinical remission in the short term, with higher improvement in QoL and medication adherence over a 12-week span [35]. Further studies are needed to evaluate TECCU regarding cost effectiveness and efficacy over longer periods of time. Additionally, it is still only available in Spain which limits its use.

myIBDcoach is a web-based telemedicine system developed by researchers in the Netherlands that can be accessed via the web or an HTML app on a tablet or smartphone. Patients complete a comprehensive monthly monitoring questionnaire and are then given personal care plans and provided e-learning modules about IBD-related topics. A multicenter trial assigned patients to use myIBDcoach (n = 465) or standard of care; the group using myIBDcoach had significantly lower outpatient visits and hospitalizations at 12 months. No significant differences were seen for number of flares, steroid use, surgeries, or ED visits [36]. A feasibility study showed high satisfaction and compliance of both patients and providers, with 93% of patients reporting they would recommend it to others [37]. myIBDcoach was also associated with reduced healthcare costs and enabled continued monitoring of quality indicators [38]. Unfortunately, it is only available in the Netherlands and is not commercially available.

Ayble Health is a commercial app that uses an interactive, mobile-delivered elimination diet program powered by machine learning for patients with IBD and/or irritable bowel syndrome (IBS) [39]. Patients record symptoms and dietary intake daily, and a novel machine learning algorithm dynamically guides patients through a four-phase elimination diet consisting of trigger identification, elimination, reintroduction, and maintenance. Ayble offers the ability to connect with a GI provider, although it does not connect with your own GI care team or have physicians able to manage medications as part of its platform. They also provide access to mental health services via their ‘Mind-Gut Program’, such as cognitive behavioral therapy and gut-directed hypnosis. In their own 9-week personalized elimination diet study consisting of patients with both IBS and IBS/IBD overlap, IBD symptom scores significantly improved (55% reduction in Simple Clinical Colitis Activity Index (SCCAI) for those with UC, 41% reduction in Mobile Health Index for CD for those with CD), even moreso than the IBS symptom score. 62.5% of patients with IBS/UC and 77.8% of patients with IBS/CD had achieved symptomatic resolution by the end of the study [40]. This is the first precision dietary intervention for patients with IBD that personalizes nutrition recommendations based on unique demographic and lifestyle characteristics. Overall, Ayble showed strong participant engagement, compliance, and satisfaction scores. However, it should be noted that they did not record data to assess active intestinal inflammation, such as fecal calprotectin or endoscopic reports. Additionally, Ayble was a financial sponsor of the study and contributed to study design. Ayble is fully covered by some health insurance plans or can be accessed for a monthly fee.

Oshi Health is a mobile app designed for patients with IBD, IBS, and other chronic GI conditions [41]. It connects patients virtually with board-certified GI physicians, dieticians, psychologists, and health coaches. Users can track symptoms weekly, are able to contact their healthcare team via secure messaging on the app, and have access to IBD-related educational materials. Uniquely, Oshi can integrate data from wearable fitness trackers to optimize care. Oshi ran a 9-month prospective trial with 332 patients with IBD, IBS, or other related functional GI disorder. 80% of patients remained engaged in the 9-month program, with patients averaging more than 10 visits with Oshi Health clinicians [42]. 98% of patients reported satisfaction with the program, 89% reported improvement in QoL, and 92% reported symptom improvement. Patients also reported 1.3 fewer missed workdays per month and, overall, there was a 64% reduction in GI-related ED visits. A third-party analysis demonstrated a reduction in GI-related costs of $6,724 per patient and in all-cause healthcare costs of $10,292 per patient after 6 months in the program. Of note, Oshi presented this data at the Institute for Healthcare Improvement Forum, and although they report that the study was externally validated, the data is not publicly available to review other than in their press statement. Oshi Health is a covered benefit by many major healthcare insurances (Aetna, United Healthcare, Cigna, among others) and does have an option for $250 per visit if not in-network. Given its availability, integration with healthcare technology, and coverage under major insurance providers, Oshi Health appears promising as an integrated app option for IBD patients. Further large-scale RCTs, in addition to coverage by more healthcare networks, will be necessary for widespread use of the app.

MyGIHealth is a cloud-based app created by My Total Health, partnering with Gastroenterologists and researchers at the University of Michigan and Cedars Sinai, that enables patients to track symptoms and review a robust educational library to better understand their symptoms [43]. The app uses smart logic to “interview” users about their symptoms and writes a report, or history of present illness (HPI), which can be provided to physicians to quickly assess symptoms and guide treatment. When reviewed by independent physician reviewers, the app-generated HPIs were found to be more complete, more useful, better organized, and more comprehensible than physician HPIs [44]. Based on users’ symptoms, the app can connect patients with healthcare professionals, educational materials, or community networks for help with their disease. The app also produces a personalized report that shows patients how their symptoms compare with those with similar disease states. Of note, they have begun actively recruiting participants and partner with both academia and pharmaceutical companies for RCTs. Although they have clinical validation of their novel HPI creator, further research into the efficacy of the app itself on patient outcomes would be beneficial before being widely adopted by users.

Trellus Health was founded in 2020 by physician scientists at Icahn Mount Sinai School of Medicine and takes a “resilience-first” approach to management of patients with IBD and IBS [45]. Trellus created the Trellus Elevate program, which is a HIPAA-compliant digital platform that provides patients with access to a team of nurse educators, dietitians, and health coaches. Trellus Elevate provides one-on-one virtual sessions to support them between office visits and gives access to tools for resilience management, behavior modification, remote monitoring, and health maintenance. The Trellus research team has provided evidence that patients using their novel resilience-based integrated IBD approach had a 71% reduction in ED visits, 49% reduction in opioid use, and 73% reduction in corticosteroid use compared to standard of care [46]. Trellus has also partnered with some of the largest healthcare insurance providers, including United Healthcare, to have Trellus Elevate as a covered benefit for qualifying patients. Although less nutritionally focused than the other apps discussed, Trellus is unique, effective (although warrants larger-scale study), and potentially worth incorporating in a holistic approach to IBD care.

Wearable devices

Recent advances in the health technology space have increased the potential utilization of wearable devices, such as Smart Watches, in health care. Wearable devices have been used in the healthcare setting extensively for various conditions, but data on the specific use for IBD is limited. A survey of 400 patients with IBD revealed that 42.7% of the subjects reported current or prior use of wearable devices. Moreover, 89% of subjects believed wearables can reveal important information about their health, and 93.8% said they would use wearables if it could help with IBD management [47].

Langenberg et al. used a triaxaial accelerometer, worn around the waist, to track activity of IBD patients and found that patients with CD overall were more sedentary and completed fewer bouts of moderate-vigorous exercise when compared to healthy controls [48]. Yi et al. had 37 post-operative IBD patients use a wearable biosensor, Fitbit Charge, throughout their hospital stay to track daily steps, sleep duration, and sleep quality. Shorter sleep durations later in the post-operative course [day 4 (r = 0.51, p = 0.043), day 5 (r = 0.81, p = 0.0045)] or higher sleep efficiency later in the post-operative course [day 5 (r=−0.77, p = 0.0098)] was associated with a shorter length of stay. Additionally, they found a significant interaction on multivariable linear regression modeling between post-operative complications and step count, suggesting that more physical activity post-operatively was associated with reduced length of stay [49]. Sossenheimer et al. used Fitbit measurements of heart rate and daily step count to predict disease activity, as measured by serum c-reactive protein (CRP) and fecal calprotectin. They found that daily step count, but not heart rate, was decreased prior to a subsequent elevation in CRP and fecal calprotectin (mean 6062 vs. 8541 steps daily, p < 0.001) [50]. This suggests that step count could be a predictive measure of disease activity.

Heart rate variability (HRV) is a measure of small differences in time between heart beats, a validated surrogate marker of vagal tone, that is measured by many commercially available wearable devices. Low HRV has been found to provide strong insight into healthcare characteristics and is associated with all-cause mortality [51, 52]. McGarva et al. tracked HRV in 41 IBD patients using Fitbit Inspire and found that low HRV was associated with more feelings of fatigue (r=−0.38, p = 0.04) and higher impact of fatigue on daily functioning [53]. Hirten et al. followed 15 patients with UC for 9 months, measuring their HRV using a wearable device called the VitalPatch. They found that low HRV was associated with an increase in UC symptoms, CRP, and fecal calprotectin [54]. Furthermore, significant HRV changes from a patient’s baseline developed before identification of a UC flare, which was based on defined increases in SCCAI score, fecal calprotectin, or CRP. Hirten et al. then performed another study with 309 patients who filled out daily disease activity surveys while wearing an Apple Watch, FitBit, or Oura Ring, while also obtaining periodic labs to monitor disease activity such as CRP, erythrocyte sedimentation rate, and fecal calprotectin [55]. HRV, heart rate (HR), and resting heart rate (RHR) differed when patients had inflammation as noted by laboratory monitoring. Further, HRV, HR, RHR, step count, and blood oxygen levels were significantly altered up to 7 weeks before inflammatory (based on elevated inflammation biomarkers) and symptomatic flares (based on daily Patient Reported Outcome scores). These studies show the potential utility of passively monitored variables, such as HRV, for disease monitoring of IBD patients; however, these studies are exploratory and small in scale.

New wearable devices are seeking to expand their capabilities for patients with IBD. Specifically, a new sweat-sensing device by EnLiSense, IBD AWARE, can continuously measure inflammatory markers from sweat of participants via electrochemical impedance spectroscopy. An initial study by Jagannath et al. collected sweat of 26 healthy subjects to evaluate levels of IL-1B and CRP. They demonstrated a Pearson correlation of r = 0.99 and r = 0.95 of IL-1B and CRP, respectively, between the sweat-sensor and ELISA (gold standard testing), proving feasibility of this technology for passively monitoring inflammatory markers via sweat [56]. Hirten et al. recruited 16 patients with IBD to wear IBD AWARE continuously to measure CRP and IL-6. They demonstrated a linear relationship between serum and sweat readings of CRP and IL-6 based on individual linear correlation coefficients. Further, comparison of sweat CRP measurements between patients with active IBD and healthy controls distinguished an inflamed and uninflamed state with a sensitivity of 82% and specificity of 70% [57]. Currently, a German study is utilizing a mobile app that connects to two wearables (SENS motion accelerometry leg sensor and Garmin smartwatch) as part of the FilgoColitis study to investigate QoL, psychosocial wellbeing, and patient-reported outcomes of IBD patients taking filgotinib [58]. The study is expected to conclude in 2026 but shows the promise of incorporating wearable technology into the study and monitoring of patients with IBD.

Discussion

Overall, there appears to be a shift in the remote healthcare delivery of IBD from web-based apps (i.e. Constant Care) and telephone-based monitoring (i.e. UC HAT) to mobile phone apps, which is logical given the relatively recent ubiquity of smartphones. The highlighted features of these mobile phone apps vary, and this may create difficulty for patients with IBD to determine which app best suits their needs. These apps often include features that impact IBD symptoms, including nutrition and meal-tracking, mental health improvement, stress reduction, patient education, easier accessibility to providers, symptom tracking, and medication management (Fig. 1). For example, patients may benefit from a nutrition and meal-tracking based app such as Ayble, where patient’s diets can be adjusted using artificial intelligence (AI) or professional assistance to learn trigger foods to avoid. However, Ayble is not covered by insurance, does not integrate wearable data, and does not integrate as seamlessly with the clinical team when compared with other apps like UCLA eIBD or HealthPROMISE. While this space benefits from a plethora of options to fit consumer needs, no single app appears to have created market dominance nor provides a one-stop-shop for the variety of healthcare needs IBD patients might require.

Fig. 1.

Common features included on mobile apps for IBD management and ways they impact IBD phenotype

One crucial benefit of these remote healthcare technologies is that they may create a large trove of patient data to help improve IBD care, such as with IBD Qorus. IBD Qorus is a multicenter, prospective quality improvement program created by the Crohn’s and Colitis Foundation to streamline and improve the quality of IBD care [59]. It was the first group to use this model, creating a common database to track outcomes and improve patient care quality from centers in 25 states around the US. Growth in mobile app use could create opportunities to use patient data, such as recorded diets, medications, and symptoms, to learn more about the disease and help guide patient management based on large data sets. Some new comprehensive care apps, like Trellus and My GI Health, have founders tied to large university centers, which may further expand the ability to use patient data for research purposes. It remains critical for these apps to maintain stringent HIPAA compliance and data privacy protections.

One major factor underlying the eventual growth of these remote IBD technologies is cost. In the aggregate, patients with IBD often face greater costs both related to missing work and increased healthcare expenses; therefore, extra expenses like a mobile app to help their disease may be a difficult barrier to overcome [60–63]. Some apps, like Oshi and Trellus, have worked with healthcare insurance companies to make cost less of an issue for patients. Given that many of these apps are created as an entrepreneurial venture and require significant startup costs, they often have a fee-for-subscription model. Companies collaborating with insurance companies to assure coverage of these IBD apps may be an effective method to reduce costs for patients. However, insurance coverage variability and disparities in access to healthcare, especially in the US, create a significant barrier. Although some cost-benefit analysis of digital health technologies in IBD exist in the literature [64–66], further exploration is needed to incentivize insurance companies to make these technologies more affordable for patients. Additional research on the long-term outcomes of patients using these technologies would also be beneficial for more accurately defining their benefit and for addressing cost-effectiveness.

These mobile apps allow patients to track health information, participate more easily in their own healthcare, and access resources that better suit their individual needs. But the real promise of these apps is the ability to personalize and adopt behavior changes based on the real-time user data. Of course, medication to reduce colonic inflammation will remain the backbone of IBD care. However, the myriad of factors that play into IBD pathogenesis lead to great interpersonal variability, which is why these apps have such a unique ability to revolutionize care for IBD patients. Furthermore, the rapid development of AI may augment and accelerate this revolution. Although not performed in patients with IBD, a multicenter RCT showed that an AI-assisted personalized diet performed similarly to a low FODMAP diet in patients with IBS, showing the potential of AI-assisted dietary modifications in disease control [67]. One app that uses AI for a similar purpose is Ayble Health, which uses AI to discern trigger foods and optimize patient diets. Further AI development is an exciting avenue for these apps to improve patient experience and tailor solutions specifically for each patient.

Although in its infancy, wearable technologies could eventually play a role in these mobile apps for IBD care. For example, HRV can be collected from most commercial smartwatches and has been shown to significantly change before UC flares. Therefore, one could postulate that incorporating smartwatch data into a remote tracking app may provide patients and providers with another marker for early detection of an IBD flare. However, further data is needed to strengthen the link between HRV and IBD disease state, as it was only one study that showed this correlation. Even further down the line includes the IBD AWARE device that can track certain biomarkers in sweat. This technology is still in the validation phase and could be many years away from potential adoption in the commercial app market.

Although a potentially useful tool, these mobile health technologies have limitations. First, user adherence in the long-term remains unclear. Previous research has identified app features that can help increase user adherence, such as social networking and gamification [68]. However, longer-term studies would be useful to track patient adherence and identify barriers to continued use with these IBD-related apps. Digital literacy is an issue as well, especially for older patients with IBD who may be less tech-savvy. Although this issue may lessen over time as technology incorporates further into healthcare and daily life, addressing gaps in digital literacy would help increase utility of these IBD mobile health technologies.

Recent advances in mobile health technologies have allowed for extension of the healthcare provider, allowing patients easier access to healthcare resources, including in the IBD space. The future of mobile health technologies shines brightly and is ripe for innovation in the coming years. Although the apps discussed in this review have been studied and show benefit to patients with IBD, larger and more RCTs are needed to better elucidate the patient experience and define health outcomes. With the ease of app creation and growing impact of social media on healthcare trends [69, 70], patients would benefit from clinicians who can help them navigate these apps, even if there is not concrete data yet supporting their efficacy. Additionally, research into how these mobile apps affect dysbiosis in IBD patients is necessary. Despite research linking the bidirectional relationship between IBD and dysbiosis, there is currently no research that investigates if/how dietary modifications via apps affects the gut microbiota in IBD patients. Considering a major feature of these apps is dietary modification for symptom control, a knowledge gap remains regarding the microbiota factors influencing this change and the impact of dietary changes on inflammation. Further, incorporating aspects of the evolving field of telenutrition, such as dietary recall, may be a useful adjunct for these apps. There are many validated apps available for tracking nutritional intake, but there is an emerging marketplace for apps that address the unique needs of patients with IBD. One example is IBDNutricare, a validated dietary recall app specifically geared toward patients with IBD in the Indian population [71]. Finally, there is a need for interdisciplinary digital platforms that can integrate between gastroenterologists, nutritionists, psychologists, and other healthcare team members to best deliver patient care. Some apps are already working on this full-scale integration, and it is necessary for the holistic management needs of patients with IBD. Due to the interpersonal variability in IBD pathogenesis, there is great potential for these apps to help clinicians learn more about individual triggers and help tailor treatments using real-time patient health data.

Abbreviations

IBD

Inflammatory Bowel Disease

CD

Crohn’s Disease

UC

Ulcerative Colitis

GI

Gastrointestinal

QoL

Quality of Life

RCT

Randomized Controlled Trial

IBS

Inflammatory Bowel Syndrome

UC HAT

home automated telemanagement in UC

TECCU

Telemonitoring of Crohn’s Disease and Ulcerative Colitis

HPI

History of Present Illness

CRP

C-Reactive Protein

HRV

Heart Rate Variability

HR

Heart Rate

RHR

Resting Heart Rate

FODMAP

fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

Author contributions

AMB contributed to study design, literature review and interpretation, manuscript preparation, final approval of submitted manuscript. BKP contributed to study design, manuscript review, final approval of submitted manuscript.

Funding

The authors declare they have no applicable funding sources for this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.