Chronic vagus nerve stimulation in Crohn's disease: a 6‐month follow‐up pilot study

Abstract

The vagus nerve (VN) is a link between the brain and the gut. The VN is a mixed nerve with anti-inflammatory properties through the activation of the hypothalamic-pituitary-adrenal axis by its afferents and by activating the cholinergic anti-inflammatory pathway through its efferents. We have previously shown that VN stimulation (VNS) improves colitis in rats and that the vagal tone is blunted in Crohn's disease (CD) patients. We thus performed a pilot study of chronic VNS in patients with active CD. Seven patients under VNS were followed up for 6 months with a primary endpoint to induce clinical remission and a secondary endpoint to induce biological (CRP and/or fecal calprotectin) and endoscopic remission and to restore vagal tone (heart rate variability). Vagus nerve stimulation was feasible and well-tolerated in all patients. Among the seven patients, two were removed from the study at 3 months for clinical worsening and five evolved toward clinical, biological, and endoscopic remission with a restored vagal tone. These results provide the first evidence that VNS is feasible and appears as an effective tool in the treatment of active CD.

Is-there a place for vagus nerve stimulation in inflammatory bowel diseases?

“…The intensity of stimulation is generally limited by side-effects such as pain in the throat which generally disappears when decreasing intensity and/or pulse width. Generally intensity beyond 1.50 mA was not well supported in our pilot study in CD patients (Bonaz et al, 2016).…”

“…We did not observe any problem of infection either local or systemic and no VNS device was removed. The data on the first seven implanted patients after a 6-month follow-up were recently reported for the first time (Bonaz et al, 2016).…”

“…Another possibility would be to use combotherapy (drugs + VNS) to induce mucosal healing with biologics and then VNS could take over the time of its efficacy. The two pilot studies of VNS in IBD (Bonaz et al, 2016;D'Haens et al, 2016) focused on CD but VNS in UC, which involves the recto-colon, would be also of interest. IBD occurs in childhood-adolescence in about 25% (Sawczenko et al, 2001).…”

“…More recently, VNS has been shown to improve experimental models of septic shock and colitis (Borovikova et al, 2000;Meregnani et al, 2011). Translational pilot studies have been recently performed in chronic inflammatory disorders such as CD and rheumatoid arthritis (Bonaz et al, 2016;Koopman et al, 2016). In the present review, we will focus our attention on the use of VNS in IBD, especially in CD.…”

Bioelectronics: The Promise of Leveraging the Body’s Circuitry to Treat Disease

“…In these conditions pathophysiology may be manifested in the brain, peripheral nervous system or other organs whose function is, at least in part, under neural control. Targeted peripheral neuromodulation is already approved for treating urinary incontinence [9], chronic neuropathic pain [10], and sleep apnea [11] and it is being investigated for use in a rapidly expanding list of other conditions, including rheumatoid arthritis [12], Crohn's disease [13], diabetes [14], hypertension [15] and heart failure [16].…”