Inflammatory Bowel Disease: Minimizing Symptoms with a DTx Solution

What is Inflammatory Bowel Disease?

Inflammatory Bowel Disease (IBD) is characterized as a chronic inflammatory condition that affects the intestines. IBD comprises of two autoimmune diseases, Crohn’s Disease and Ulcerative Colitis, and can cause patients to experience abdominal pain, diarrhoea, fever, fatigue, and malabsorptive nutritional deficiencies. While genetic predisposition plays a key role in immune-mediated diseases, the major influence seems to be environmental factors.

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IBD affects more than 6.8 million people globally and the prevalence of IBD has been rising over the past decade. Although incidence of IBD in Asia is still relatively lower than in North America and Europe, it is increasing there, too. Substantial indirect costs arise from work productivity losses (around $2200 per patient per year, according to one study), owing to the debilitating symptoms that IBD can cause.

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As there is no cure, IBD treatment is currently limited to anti-inflammatory and immune modulatory drugs, steroids, and antibiotics. However, recent patient-centric research has identified several non-pharmacologic strategies that patients identified as being useful in self-managing their symptoms, including adjusting their diet, seeking support for pain and fatigue, sleep management, exercise, and attending to their mental wellbeing.

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While it is clear to see how improving these aspects of a patient’s life could contribute to a better quality of life, it relies upon the patient to modify their behavior, and this can be difficult to achieve without adequate support. Digital therapeutics, such as Sidekick’s platform for IBD management, are specifically designed to aid in this behavior modification in a seamless, integrated approach that keeps patients engaged day to day.

IBD are complex diseases and there is currently no cure. However, the modern drugs are able to dramatically improve symptoms, decrease complications and change disease outcome. Beyond that, the patients may play a key role in further improving their quality of life. Particularly, by acting on three pillars which are stress, physical activity and alimentation, they can further improve the control of the disease and decrease their medication need. The Sidekick Health IBD program may help them to become actor in their own disease management.
Dr. Edouard Louis, MD, PhD

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How Behavior is Linked to Health

Human behavior is increasingly being recognized as a key element in patient outcomes, especially in chronic diseases that have lifestyle-associated factors, and through behavioral economics we can begin to understand what influences the choices that people make in the real world.

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Humans tend to rely on heuristics – that is, mental shortcuts that allow faster, but often less considered judgements when problem-solving – and although these can be useful, they can also lead to errors that cause negative behavior. This is particularly problematic in the context of taking care of one’s health, where poor habits may have led to obesity, smoking or sedentary lifestyles, all of which can exacerbate a chronic disease.

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Three characteristic factors of heuristic choices are inherent to human nature and decision-making: bounded rationality, willpower, and selfishness. By understanding these limitations of humans’ instinctive decision-making, digital therapeutics can leverage these behavioral idiosyncrasies to influence patient choices in a positive way. For example, in order to counteract bounded willpower, it has been shown that motivation in the form of feedback can be powerful: receiving visual feedback on the consequences of smoking can lead to healthier habits, and daily feedback messages enhanced adherence to self-monitoring of a patient’s diet, leading to improved weight loss.

Sidekick’s IBD Program Design

Sidekick’s program is based on the principles of behavioral economics and provides a comprehensive platform of various tools a patient can use for additional support in management of their inflammatory bowel disease. The program proved its efficacy through clinical trials and has now been rolled out in six countries in Europe as well as in the US.

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Patients are empowered to control their symptoms through the use of tailored functions designed to promote the formation of positive health habits in gamified, motivational ways, thereby limiting the burden of their disease on their daily life.

With Sidekick, those affected not only receive important information about their disease, but are also supported in many everyday questions and accompanied in a motivating manner. Sidekick helps people to use their own resources and to actively tackle life with inflammatory bowel disease.
PD Dr. med. Emanuel Burri

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Key areas supported by Sidekick’s program include:

Treatment Adherence

Patients receive daily reminders and have the ability to track when they have taken their medication. By keeping to their schedule and taking treatment as prescribed, patients can make the most of their medication and help keep symptoms at bay.

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Nutrition

Food diaries enable patients to log their nutritional intake which provides both support for appropriate caloric consumption and can help identify potential dietary triggers prior to IBD flares. This can also be particularly useful for the physician or dietician to oversee how well a patient is able to adhere to a diet plan, and adjust accordingly.

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Psychological Wellbeing

Mindfulness activities and guidance on stress management can help patients take care of their mental health, and minimize the psychological burden that having a chronic condition can bring. Patients have access to meditation and breathing exercises that can help focus the mind, particularly during painful episodes, and can help build mental resilience for the future.

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Education

Informative and reliable content about inflammatory bowel disease and tips for management are easily accessed within the platform, helping the patient to understand their condition more closely and feel in control of their progress.

Two-way communication with health coaches also means patients can receive reliable advice on queries they have, helping patients to feel invested in optimizing lifestyle choices that are within their control.

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Physical Activity

Through a combination of suggested activities, set tasks and the step counter, patients can increase their daily movement in a manageable way, receiving feedback and motivational messages for increased activity levels. Increasing activity can have positive effects on fatigue levels as well as sleep, which IBD patients commonly struggle with, contributing to an improved quality of life overall.

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IBD in the Aging Population

For 2022, World IBD Day is focusing on the theme of IBD in the older population in particular. Inflammatory bowel disease has a bimodal distribution with a majority of cases being diagnosed in those aged 30-40, but with a second peak at 60-70 years. While the disease course is similar for older patients, the importance of managing acute flares is especially important as their risk of life-threatening deterioration is higher than in younger patients.

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It is also important to note that 25% of IBD healthcare costs are accounted for by 15% of IBD patients diagnosed after age 60, reflecting a disproportionate use of resources in this group, and a need for more proactive healthcare support for this patient group.

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There may be some skepticism surrounding the use of a digital health tool for elderly patients, but a recent study showed that in the US, around 73% of those 65 and older are now internet users, compared to a mere 14% in 2000 and this trend is likely to continue. These older Americans spend on average 4 hours of screen time during leisure hours every day.

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Therefore, a DTx solution for managing these patients’ IBD is a feasible and useful therapeutic option. Indeed, a recent study demonstrated that digital, online health interventions showed positive effects on sleep disturbances in the elderly, particularly in their positive effect on depression and quality of life.

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Conclusion

IBD is a chronic digestive condition that can affect young and old alike and as yet has no cure. With debilitating symptoms that manifest uniquely in different patients, IBD can be difficult to manage without sufficient support. However, with the evolution of digital health solutions like Sidekick’s, there is now an integrated therapeutic option, enabling patients to manage their symptoms more effectively and in an accessible way.

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Through behavioral modifications subtly guided through the solution, patients have the ability to improve their disease literacy, medication effectiveness, quality of their nutrition and sleep, and mental wellbeing. These individual improvements have a cumulative effect in maximizing a patient’s overall quality of life and are crucial in the optimal management of IBD.

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