# Heart rate variability as a modifiable biomarker of clinical symptoms and psychological functioning in pediatric patients with inflammatory bowel disease

> **NIH NIH R03** · EMORY UNIVERSITY · 2023 · $234,750

## Abstract

PROJECT SUMMARY
 Inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, are immune-
mediated gastrointestinal disorders associated with chronic medical and psychosocial dysfunction. IBD is
increasingly conceptualized as a product of the brain-gut axis, a model that describes the network of
communication between the central nervous system (CNS), the autonomic nervous system (ANS), the
hypothalamic-pituitary-adrenal (HPA) axis, and the gut. Consistent with a brain-gut axis model, patients with
IBD demonstrate dysfunction of the ANS indicative of a chronic stress response. ANS functioning can be
measured via heart rate variability (HRV), a non-invasive measure suitable for pediatrics. Early evidence
suggests that patients with IBD exhibit alterations in HRV consistent with ANS rigidity as well as psychological
distress and increased emotional reactivity to stress. These alterations in autonomic functioning are also
observed in individuals with anxiety and depressive disorders, and it is well recognized that youth with IBD are
at increased risk for developing chronic anxiety and depression. Biofeedback training to treat alterations in
HRV has led to improvements in disease symptoms as well as reductions in emotional distress for youth with
other chronic gastrointestinal illnesses. The goal of the proposed work is to test the utility of HRV as a
biomarker of clinical symptoms as well as symptoms of anxiety and depression in pediatric patients with IBD
who are enrolled in a biofeedback therapy program. In this R03 project, I will build on the work of my K23
(K23DK122115) to establish HRV as a clinically relevant and modifiable biomarker that can be reliably used in
treatment studies of young patients with clinical symptoms of IBD and related stress, depression, and anxiety. I
developed and am currently testing a remote HRV biofeedback-enhanced cognitive behavioral therapy (CBT)
treatment program in 40 youth with IBD and symptoms of anxiety and depression. With R03 support we will be
able to process the rich but complex raw HRV data obtained at baseline, during biofeedback sessions, and at
posttest to evaluate the trajectory of HRV in these youth currently in treatment. The overall goals of the current
study are to (1) determine the relationship between baseline HRV and clinical symptoms of IBD, anxiety, and
depression in 40 adolescents with IBD and (2) determine if HRV changes with a virtual, biofeedback-enhanced
CBT treatment intervention. This R03 offers a source of support for a new avenue of inquiry into HRV as a
brain-gut axis mechanism driving chronic psychological distress and clinical symptoms in patients with
pediatric IBD. Combined with the outcomes of the K23 research, findings will support a competitive R01 to test
efficacy of a biofeedback-enhanced CBT intervention, using HRV as a primary outcome variable and
biomarker of clinical improvement.

## Key facts

- **NIH application ID:** 10722740
- **Project number:** 1R03DK136975-01
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Bonney Reed
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2023
- **Award amount:** $234,750
- **Award type:** 1
- **Project period:** 2023-08-15 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10722740

## Citation

> US National Institutes of Health, RePORTER application 10722740, Heart rate variability as a modifiable biomarker of clinical symptoms and psychological functioning in pediatric patients with inflammatory bowel disease (1R03DK136975-01). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10722740. Licensed CC0.

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