Could Wearables (A Smartwatch) Detect IBD Before Symptoms Begin?

Crohn’s disease and ulcerative colitis, the two main forms of inflammatory bowel disease (IBD), can develop quietly before persistent diarrhea, bleeding, or abdominal pain brings the disease to medical attention. Blood tests, stool tests, and colonoscopy help identify this activity, but each provides only a snapshot at a single point in time.

In newly diagnosed, active Crohn’s disease, a randomized trial found substantially higher rates of sustained steroid-free and surgery-free remission with early infliximab-based combination treatment than with a strategy of escalating treatment as needed. This supports timely effective treatment once the diagnosis is established and raises an important question: could detecting and treating inflammation before initial symptoms or a symptomatic relapse further improve outcomes?

Wearable devices do not directly measure intestinal inflammation, but they may capture the body’s response to otherwise unnoticed inflammation, prompting earlier investigation and, if IBD is confirmed, appropriate treatment.

A recent online Medscape discussion between Mount Sinai gastroenterologists Bruce Sands and Robert Hirten described promising research using smartwatches and rings. These devices collect measurements such as heart rate, heart rate variability, sleep, and physical activity.

In a study of 309 people with established Crohn’s disease or ulcerative colitis, researchers identified changes in wearable measurements up to seven weeks before symptomatic or inflammatory flares. A separate study of 101 people found that subtle changes in sleep patterns were associated with inflammation.

Separate research involving more than 20,000 people who developed IBD found changes in inflammatory markers and other blood measurements up to eight years before Crohn’s disease was diagnosed and three years before ulcerative colitis was diagnosed. These findings suggest a prolonged period of biological change before diagnosis, although not necessarily before all symptoms. Could combining laboratory trends with wearable measurements of heart rate, sleep, and activity help identify people who need earlier investigation? That possibility is promising, but whether wearables can identify IBD before its first symptoms is still unproven.

This is where artificial intelligence could become particularly useful. Months of wearable monitoring generate enormous amounts of data, and the relevant signals may be small, inconsistent, and spread across several measurements. AI could analyze these measurements together, learn a person’s usual patterns, and identify combinations of changes that would be difficult to recognize by reviewing individual readings.

The interview article describes preliminary deep-learning research predicting flares up to eight weeks in advance in people with established IBD.

The potential is earlier recognition of inflammation, earlier diagnostic testing, and perhaps a shorter delay before appropriate care. The challenge remains in establishing that these systems can distinguish IBD from infections, stress, exercise, poor sleep, and other causes of similar changes. Researchers must also show that acting on an alert improves outcomes without producing excessive false alarms and unnecessary testing.

The exciting prospect is that AI could combine information from continuous monitoring with wearable devices and laboratory markers to help clinicians recognize the disease, especially recurrences, while its warning signs are still subtle.