Vagus nerve stimulation: a new promising therapeutic tool in inflammatory bowel disease.

J Intern Med. July 2017;282(1):46-63.

B Bonaz¹, V Sinniger², S Pellissier³

¹ University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.; ² University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.; ³ University Clinic of Hepato-Gastroenterology, University Hospital, Grenoble, France.

Abstract

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.

Article Tools:

Medline

Email to me

Databanks:

GENBANK/NCT01569503
GENBANK/NCT02311660

Archives Highlights:

Nursing care of the small animal oncology patient. Part 2: pet carer support
This article outlines how RVNs can alleviate caregiver burden, facilitate shared decision-making, and provide practical and emotional support throughout the oncology journey.

Litter box size and litter type preference and their associated behavioral changes in cats.
Our findings indicated that cats preferred litter boxes measuring ≥50 cm as well as clumping clay litter. Moreover, a comfortable litter environment combining these two elements promoted normal urination behavior while improving house-soiling (both urination and defecation).

Resolution of egg binding is possible in most client-owned parrots when multiple treatment strategies are considered.
Of the 150 events that had complete follow-up, 109 (72.7%) resulted in a successful outcome. A successful outcome was observed in 44 of 133 events (33.1%) that were initially managed medically without resorting to additional treatment strategies, in 31 events (86.1%) managed with mechanical assistance, in 20 events (60.6%) managed surgically, and in 12 events (85.7%) managed with ovocentesis.

Trust in veterinarians and association with vaccine information sources and vaccination status among dog and cat owners.
62.9% of dog and 61.2% of cat owners were classified as trusting their veterinarians. On average, dog owners consulted 2.50 sources about vaccine information; cat owners consulted 2.27 sources. Veterinarians were the most common primary sources of information for 85.4% of dog owners with high levels of trust, but only 62.6% of dog owners with lower levels. This was the case for 83.8% and 56.3% of cat owners.

Aseptic protocol breaches are common among veterinary students scrubbing, gowning, and gloving into surgery.
At least 1 aseptic protocol breach (APB) was noted in 46.3% of the 96 procedures observed. The most common mistakes noted were contact of the sterile towel onto nonsterile surfaces (17.7%), contact of the gown with nonsterile surfaces (17.7%), touching sterile objects with bare hands (12.5%), and improper scrubbing technique (17.4%).