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Abstract

The study “Physiological Data Collected from Wearable Devices Identify and Predict Inflammatory Bowel Disease Flares” evaluates how the use of wearable devices to collect physiological data can help identify inflammatory bowel disease (IBD) flares.1 The study found significant differences in longitudinal heart rate (HR), heart rate variability (HRV), as well as resting heart rate (RHR) during periods of both inflammatory (measured by elevation in CRP, ESR, or fecal calprotectin) and symptomatic flares. Additionally, the authors found that these variables were often different up to 7 weeks prior to a flare, suggesting that the use of wearable devices could aid clinicians in predicting a clinical flare even prior to IBD symptom onset.

This study demonstrated that both HR and RHR were overall higher during periods of both inflammatory and symptomatic flares and that HRV similarly differed significantly between flares and periods without inflammation. While analysis of HRV was adjusted for body mass index (BMI), age, and sex, other physiologic metrics such as HR and RHR were not adjusted for sex, highlighting an opportunity to consider how sex-specific physiologic variability may enhance the applicability of this study in clinical practice.

Sex differences in IBD disease have been well documented, with the conclusion that management of IBD should be done with consideration of a patient’s sex, as presentation, disease course, and treatment response can all vary.2 In relation to this study, autonomic function has been known to fluctuate during the menstrual cycle, with multiple studies finding that RHR fluctuates throughout the menstrual cycle, with HR often being elevated in the ovulatory and mid-luteal phases.3,4

Additionally, an elevation in CRP was used to determine signs of an inflammatory disease flare in the study, but CRP levels have been found to vary significantly across the menstrual cycle and with varying levels of progesterone as well.5 Considering these physiologic differences is relevant to this study, given that the cohort was 67% female and that wearable devices could predict a flare almost seven weeks prior to symptom onset. A period of seven weeks would certainly overlap with at least one menstrual cycle in the premenopausal female cohort, thereby potentially confounding normal physiologic variations as signs of a disease flare.

Women of reproductive age comprise a very large proportion of all patients with IBD, which underscores the importance of having disease monitoring tools that are able to provide accurate and clinically meaningful data for all patients, not just a select few.6 This study addresses a novel way to better assess and treat patients with IBD, and the consideration of sex differences, especially pertaining to the menstrual cycle and hormonal fluctuations, will only further improve the clinical utility of using wearable devices for all patient populations.

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