Review for 10.1186/s12876-025-04189-z (2025)

Title: Mobile Health Technologies in Inflammatory Bowel Disease: A Narrative Review
Version: 0 Date: 01 Jun 2025
Reviewer's report:
In this review, the authors provide an overview of some of the mobile health technologies that
currently exist for patients with IBD. This is a rapidly expanding field and the need for a review
of available technologies would be helpful, however there are major concerns with this review
as well as several areas that need minor edits.
-In the first sentence, “Care for inflammatory bowel disease” should be “Care for patients with
inflammatory bowel disease” or “Care for inflammatory bowel disease patients”.
-In the introduction, ulcerative colitis should not be capitalized.
-The authors state that inflammatory bowel disease is characterized by “uncontrolled
inflammation of the GI tract” however when patients have control of their inflammation, they
still have IBD. I would suggest using a clearer definition of IBD.
-The authors state that “there appears to be a significantly increasing prevalence” when data
shows that there clearly is a significantly increasing prevalence. The “appears” can be omitted
here.
-In line 62, “patient” is not needed to describe quality of life.
-The description on gut dysbiosis is extensive and seems to be beyond the scope of this review.
The authors try to connect gut dysbiosis and mobile monitoring in the discussion, but this section
could be trimmed quite a bit.
-In line 74, the authors comment on the use of dietary modifications for symptom management
and relapse prevention which is not true. Diet can impact symptoms, but we have no studies that
show that dietary intake triggers active intestinal inflammation nor can dietary modifications
treat intestinal inflammation. This statement needs to be corrected.
-In line 77, the author indicate that consistent monitoring is needed due to the relapsing and
remitting nature of the disease, when, in fact, more frequent monitoring using objective markers
of inflammation is needed to detect asymptomatic patients with active inflammation as there is
a lack of correlation between symptoms and intestinal inflammation in many patients. The goal
is to detect the recurrence or presence of active inflammation to allow for early intervention to
try to avoid ER visits, hospitalizations, need for steroids and complications of disease.
-In line 81, the authors indicate that these mobile technologies “shift more care into patients’
hands” when, in fact, the objective is to provide ancillary services (such as nutritional support or
mental health support) due to lack of these resources locally or due to limited time in the clinic
with providers and, for the wearable monitoring devices, to find reliable, easy ways to monitor
for worsening disease activity without stool testing or invasive procedures (like colonoscopy).
-The authors need to provide references for the review articles mentioned in line 104.
-In line 119, the authors mention that weekly calprotectin levels are collected for the Constant
care app. Who is ordering these studies and who is responsible for monitoring / responding to
the results? If this information is shared with their IBD physician, do the patients sign consent
to use this platform? More specific details on the set up and monitoring for the use of this app
are needed.
-In line 130, the authors also mention that “extensive healthcare support” is required. Can you
provide more specifics?
-The section on UC HAT does not provide any information on the availability of this web-based
platform. Also, please provide statistics for the study results included here, particularly if these
are listed as a “significant decrease”.
-IBD QORUS is actually a multicenter, prospective, ongoing quality improvement program
including academic centers and private practices (need to update line 152) and is not a mobile
health technology as patients complete symptom based surveys at the time of clinic visits to help
guide further evaluation and/or treatment changes. This does not fit with this review.
-In line 172-3, the authors indicate that the review of personal mobile application will only
include thos that “have been clinically studied and validated” however the last 2 apps that are
reviewed do not meet this criteria. This statement either needs to be deleted or those 2 apps
should be excluded from this review.
-In line 189, the authors indicate that “Quality of care improved” but there are no criteria
included to define this result. Please include what objective measures were used to measure this
improvement and include statistics.
-In line 200, use of eIBD led to “significantly fewer upper endoscopies” however it is unclear
why IBD patients were getting upper endoscopies anyway? Also, the authors should include
statistics here.
-In line 216, the authors include improvements including “higher rates of remission” and
“improvement in disease activity” however it is unclear how these are different outcomes. What
variables were used to measure these outcomes? Similarly, in line 220, the authors indicate the
outcome of “remission” but it is unclear if this is clinical, biochemical or endoscopic remission
and what criteria were used to determine “remission”. More detail is needed here.
-In line 229, the authors need to include statistics to support the claim of “significantly lower
outpatient visits…”.
-Is the “Mind-Gut Program” in the Ayble program disease specific (meaning is the an IBD
program and an IBS program) or a one-size fits all? Also, the authors indicate that “70% of
participants” say improvement, but what percentage of that cohort were IBD patients? We
know these programs help for IBS, but there is no data to support these interventions for active
intestinal inflammation. The caveat that the “GI Expert” has limited capabilities should be
included as the authors mention that “ability to connect with a GI provider”.
-In line 258, the authors need to clarify what percentage of the 332 patients studies were in each
disease cohort and what percentage of the listed results relate to the IBD cohort.
-Further, the authors should combine the blanket statement that OSHI is covered by insurance
and the caveat that currently that only Aetna and United Healthcare. In addition, OSHI isn’t
really an app; it’s more a telemedicine platform.
-In line 324, “89% of subjected believed” should be “subjects”. The authors need to include
statistics to the cited findings in this section. Further, “C-Reactive Protein” doesn’t need to be
capitalized.
-The authors need to include statistics to support the cited results in the HRV paragraph. In
addition, it is unclear what is meant by “HRV was associated with UC symptoms, CRP and fecal
calprotectin”. Does this mean that decreased HRV was associated with increased UC symptoms,
increased CRP and fecal calprotectin levels? This association needs to be more clearly defined.
Also, does “before identification of a UC flare” mean prior to the onset of symptoms or prior to
an increase in CRP and/or calprotectin? Please clarify.  Also, “Erythrocyte Sedimentation Rate”
does not need to be capitalized. Finally, it is unclear what the authors mean by “inflammatory
and symptomatic flares”.
-In the discussion, the authors mention that app features “impact IBD phenotype” which doesn’t
make sense as the disease phenotype typically refers to whether a patient has inflammation
alone (non-penetrating, non-stricturing disease), penetrating or fistulizing disease, or stricturing
disease. None of these phenotypes have been shown to be impacted by the use of mobile health
technologies.