Review: Digital Health for Functional Gastrointestinal Disorders
Key findings
- "High-touch" care for functional gastrointestinal disorders (FGIDs)—customized diets, psychotherapy, frequent patient–clinician interactions, and robust peer support—significantly improve treatment results but are difficult to integrate into the clinic
- Digital tools for patients with FGIDs, including symptom trackers, wearable devices, telemedicine platforms and virtual peer support, are now available, and there is promising preliminary evidence of effectiveness for some of them
- Steps that could result in wider adoption of digital health for FGIDs are more rigorous research, more reliable business models, and unified programs that fit better into clinical workflows and allow providers to individualize patient care
Few conditions are better suited to digital health tools than functional gastrointestinal disorders (FGIDs, or disorders of gut–brain interaction). Growing evidence shows customized diets, psychotherapy, frequent patient–clinician interactions, and robust peer support significantly improve FGID treatment results, but all are difficult to implement in traditional practice.
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Physicians in the Division of Gastroenterology at Massachusetts General Hospital recently reviewed advances in digital tools for FGID and how they might improve care in the future. Mythili P. Pathipati, MD, a clinical fellow, Braden Kuo, MD, director of the Center for Neurointestinal Health and assistant professor of Medicine at Harvard Medical School, and Kyle D. Staller, MD, MPH, director of the Gastrointestinal Motility Laboratory, member of the Clinical and Translational Epidemiology Unit, and assistant professor of Medicine at Harvard Medical School, present their perspectives in Neurogastroenterology & Motility.
Symptom Tracking Platforms
Clinicians must normally rely on patients to track the many possible symptoms of FGID against their diet, behaviors and other stimuli. Web and mobile apps improve compliance with this task and prompt patients to fill in relevant data, resulting in more complete, less biased histories. Symptom trackers mentioned in the review are:
- Bowelle—App that tracks symptoms, food and water intake, mood, stress, sleep, activity and bowel movements
- mySymptoms—Similar to Bowelle except it also tracks medication use and does not track mood
- Auggi—Algorithm that correlates patient-captured stool images to a logged diet
- Dieta—App that predicts triggers and recommends behavioral changes based on tracked symptom and activity data
High volumes of food and bowel data can overwhelm clinicians and be only marginally useful, so the as-yet-unrealized opportunity is for symptom trackers to identify and report relevant metrics.
Digitally Connected Wearable Devices
Consumer wearables link subjective symptom data to objective physiologic findings. For example, a symptom tracker can be connected to a health metric–enabled smartphone to determine how step counts, sleep or vital signs affect symptoms.
Technologies such as AbStats (worn on the abdomen to record bowel sounds and evaluate bowel function) and the G-Tech Patch System (wireless electrode patches that detect electrical signals from the GI tract) are still investigational for FGID management. A key question is how their abstract measurements translate into addressable physiology.
Telemedicine
Patients with FGIDs benefit from extensive contact with clinicians, and virtual visits can address many services that have limited in-person availability. Examples are cognitive–behavioral therapy, gut hypnotherapy, pelvic floor physical therapy, and dietary counseling. Several GI-specific telemedicine programs have yielded encouraging preliminary data:
- Mahana IBS—A three-month digital cognitive behavioral therapy program for patients with irritable bowel syndrome (IBS)
- Cara Care—A combination of free symptom tracker and paid therapeutic program for IBS comprising education, hypnosis and behavioral therapy
- Oshi Health—A virtual GI clinic with access to gastroenterologists, nutrition and mental health counseling, health coaching and other services
Virtual Peer Support
Peer-to-peer support networks and group education programs that address isolation, embarrassment and stigma have been shown to improve FGID symptoms. Two specific to IBS are IBS Patient and IBS Self Help and Support Group.
Social media and other digital networks provide patient support globally, but the content must be monitored to prevent the spread of misinformation.
Future Directions
Three major steps could result in wider adoption of digital health tools for FGIDs:
Rigorous research—New studies need to be large, prospective and controlled; include representative populations, not just digital natives; investigate outcomes over a year or more; and investigate targeted questions, not simply collect immense amounts of data and retrospectively parse it looking for correlations.
Reliable, replicable business models—Currently it's not clear who the customer is for digital health interventions. Various companies promote ad-supported free products, sell services directly to the patient, charge the provider with the expectation that the provider will seek reimbursement, seek reimbursement from payers directly, form physician–industry partnerships, or contract with employers. Some of these models are unsustainable and the company fails, which increases patient and clinician distrust.
Unified programs—Combining symptom trackers with wearables, virtual visits and other offerings would allow clinicians to customize tools for each patient's needs. Programs also need to fit into provider workflows by reporting clinically relevant metrics and integrating with electronic medical records and other technology.
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