Can Heart Rate Variability Predict Pediatric IBD Worsening?

Illustration showing a heart overlaid with a normal electrocardiogram (ECG).
Researchers sought to determine whether heart rate variability could predict clinical outcomes in pediatric inflammatory bowel disease.

Heart rate variability (HRV) is associated with inflammatory bowel disease (IBD) activity and may predict disease exacerbation in children with IBD, according to study results published in the Journal of Psychosomatic Research.

Researchers conducted a prospective study, which included 34 children (24 boys, 10 girls; mean age, 15.3±2.2 years; 62% in clinical remission; 38% with active disease) with IBD. Participants were given 2 10-minute measurements of HRV using a photoplethysmograph finger sensor. To assess vagal activity, the study researchers calculated the square root of the mean squared differences between consecutive R-R pulse intervals (RMSSD). Follow-up lasted 12 months, during which demographic variables, medications, disease activity and progression, and laboratory data were recorded. The association between RMSSD and clinical outcomes was assessed using univariate and multivariate logistic regression models with adjustments for confounders.

The subgroup in remission had significantly higher RMSSD compared with those in the active disease subgroup (67.72±27.81 vs 45.76±22.04; P =.022). Results from multivariate analysis showed that higher RMSSD significantly and independently predicted lower risk for IBD exacerbation (odds ratio [OR], 0.941; 95% CI, 0.887-0.998; P =.044). To account for the relatively small size of the study sample, the association between HRV and exacerbation was retested with a univariate nonparametric Spearman correlation test and was still significant (Rho=-0.581; P =.001).

Limitations to this study included a small cohort size, an inability to conduct multivariate analysis on all IBD outcomes, and an inability to determine causality.

“The implications of these results for the pathogenesis and treatment of IBD remain to be elucidated,” the study authors noted. “Further studies are needed to evaluate the role of HRV as a noninvasive tool for the assessment of IBD activity, and interventional studies are needed to evaluate the effect of vagal nerve activation on chronic inflammation and progression in pediatric IBD.”


Yerushalmy-Feler A, Cohen S, Lubetzky R, et al. Heart rate variability as a predictor of disease exacerbation in pediatric inflammatory bowel disease. J Psychosom Res. Published online April 12, 2022. doi:10.1016/j.jpsychores.2022.110911