Vagus nerve stimulation: a new promising therapeutic tool in inflammatory bowel disease
Open accessAbstract
Inflammatory bowel disease (IBD), that is Crohn's disease (CD) and ulcerative colitis, affects about 1.5 million persons in the USA and 2.2 million in Europe. The pathophysiology of IBD involves immunological, genetic and environmental factors. The treatment is medico‐surgical but suspensive. Anti‐TNFα agents have revolutionized the treatment of IBD but have side effects. In addition, a non‐negligible percentage of patients with IBD stop or take episodically their treatment. Consequently, a nondrug therapy targeting TNFα through a physiological pathway, devoid of major side effects and with a good cost‐effectiveness ratio, would be of interest. The vagus nerve has dual anti‐inflammatory properties through its afferent (i.e. hypothalamic–pituitary–adrenal axis) and efferent (i.e. the anti‐TNFα effect of the cholinergic anti‐inflammatory pathway) fibres. We have shown that there is an inverse relationship between vagal tone and plasma TNFα level in patients with CD, and have reported, for the first time, that chronic vagus nerve stimulation has anti‐inflammatory properties in a rat model of colitis and in a pilot study performed in seven patients with moderate CD. Two of these patients failed to improve after 3 months of vagus nerve stimulation but five were in deep remission (clinical, biological and endoscopic) at 6 months of follow‐up and vagal tone was restored. No major side effects were observed. Thus, vagus nerve stimulation provides a new therapeutic option in the treatment of CD.
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The brain-gut axis is becoming increasingly important as a therapeutic target for gastrointestinal and psychiatric disorders, such as inflammatory bowel disease, depression, and posttraumatic stress disorder.
“The brain–gut axis is becoming increasingly important as a therapeutic target for gastrointestinal and psychiatric disorders, such as inflammatory bowel disease (IBD) (3), depression (4), and posttraumatic stress disorder (PTSD) (5).”
From Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders (2018) · cites this paper as [3]
In response to pathogens and other injurious stimuli, TNF-α is produced by activated macrophages, dendritic cells, and other cells in the mucosa.
“For example, in response to pathogens and other injurious stimuli, tumor-necrosis factor-alpha (TNF-α), a cytokine, is produced by activated macrophages, dendritic cells, and other cells in the mucosa (3, 65).”
From Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders (2018) · cites this paper as [3]
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- Authors
- Bonaz, B., Sinniger, V., & Pellissier, S.
- Affiliations
- Inserm (FR)
- University Clinic of Hepato‐Gastroenterology University Hospital Grenoble France
- Corresponding author
- Bonaz, B.
- Venue
- Journal of Internal Medicine
- Publisher
- Wiley
- Published
- 2017-04-18
- Volume
- 282
- Issue
- 1
- Pages
- 46-63
- ISSN
- 0954-6820 (ISSN-L)
- 1365-2796
- OpenAlex
- W2607217038
- Cited by
- 213
- References
- 118
- Citations by year
- 2026: 28 · 2025: 36 · 2024: 19 · 2023: 23 · 2022: 16 · 2021: 17 · 2020: 25 · 2019: 18 · 2018: 22 · 2017: 9
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- green
- hal.science
- Locations
- Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Vagus Nerve Stimulation Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- vagus nerve stimulation, inflammatory bowel disease, Crohn's disease, ulcerative colitis, cholinergic anti-inflammatory pathway, vagal tone, TNF-α, hypothalamic-pituitary-adrenal axis, anti-TNF therapy, deep remission, rat colitis model
- MeSH terms
- Afferent Pathways, Complementary Therapies, Animals, Disease Models, Animal, Efferent Pathways, Humans, Splanchnic Nerves, Spleen, Vagus Nerve, Inflammatory Bowel Diseases, Vagus Nerve Stimulation
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