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/NCT02311660
GENBANK/NCT01569503

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.

Indications for Radiation Therapy in Veterinary Medicine
This article highlights some of the essential elements for clinical decision making in veterinary radiation oncology, with case examples to give general practitioners a better understanding of what types of cases may be appropriate for radiation therapy.

Owner survey suggests cats may be undertreated for pain compared to dogs after an elective ovariohysterectomy or orchiectomy.
Analgesics were prescribed for 19 of 162 (12%) pets: 14 of 88 (16%) dogs and 5 of 74 (6.7%) cats. There was no difference in the prescription of analgesics between dogs and cats after ovariohysterectomy or orchiectomy. 15 of 19 owners reported their compliance in administering analgesics at 78.9%. Owners' subjective assessments showed that 24 of 86 (28%) dogs and 12 of 68 (17%) cats appeared painful at home.

Feline blood donation: Description and adverse reactions from 29 201 donation events between 2019 and 2023.
Adverse reactions were uncommon (0.29%, 2.88/1000 donor events) and most commonly were cardiorespiratory (0.08%, 0.75/1000 donor events) or behavioral (0.06%, 0.62/1000 donor events). The only risk factor significantly associated with adverse reactions was conscious donation, with conscious donors 4.4 times more likely to have an adverse reaction.

Use of Dog Serologic Data for Improved Understanding of Coccidioidomycosis: A One Health Approach.
The overall seropositivity rate among tested dogs was 37.6%. Average test positivity rates in states with =0.5 tests per annum per 10,000 households were 35.4% (Texas) to 74.1% (Montana). For these states, average annual incidence per 10,000 households was as follows: Arizona (86.8), New Mexico (0.89), Nevada (0.78), California (0.75), Montana (0.63), Colorado (0.41), Oregon (0.41), Texas (0.38), Idaho (0.37), Wyoming (0.34), Utah (0.32), and Washington (0.26). Human incidence in California and Arizona between 2012 and 2022 was significantly correlated with dog incidence.