Impact of auricular percutaneous electrical nerve field stimulation on gut microbiome in adolescents with irritable bowel syndrome: A pilot study

Abstract

ObjectivesPercutaneous electrical nerve field stimulation (PENFS) has documented efficacy for irritable bowel syndrome (IBS) via plausible vagal neuromodulation effects. The vagus nerve may affect gut microbiome composition via brain–gut–microbiome signaling. We aimed to investigate gut microbiome alterations by PENFS therapy in adolescent IBS patients.MethodsA prospective study of females with IBS aged 11–18 years receiving PENFS therapy for 4 weeks with pre‐ and post‐intervention stool sampling was conducted. Outcome surveys completed pre‐therapy, weekly, and post‐therapy included IBS‐Severity Scoring System (IBS‐SSS), Visceral Sensitivity Index (VSI), Functional Disability Inventory (FDI), and the global symptom response scale (SRS). Bacterial DNA was extracted from stool samples followed by 16S rRNA amplification and sequencing. QIIME 2 (version 2022.2) was used for analyses of α and β diversity and differential abundance by group.ResultsTwenty females aged 15.6 ± 1.62 years were included. IBS‐SSS, VSI, and FDI scores decreased significantly after PENFS therapy (P < 0.0001, P = 0.0003, P = 0.0004, respectively). No intra‐ or interindividual microbiome changes were noted pre‐ versus post‐therapy or between responders and non‐responders. When response was defined by 50‐point IBS‐SSS score reduction, α diversity was higher in responders compared with non‐responders at week 4 (P = 0.033). There was higher abundance of Blautia in excellent responders versus non‐responders.ConclusionsThere were no substantial microbial diversity alterations with PENFS. Subjects with excellent therapeutic response showed an enrichment of relative abundance of Blautia, which may indicate that patients with specific microbial signature have a more favorable response to PENFS.

A multicenter registry study on percutaneous electrical nerve field stimulation for pediatric disorders of gut–brain interaction

“…Although speculative, it is conceivable that altered brain connectivity may be responsible for the long‐term improvements. Other proposed PENFS mechanisms to some degree supported by data include: (1) restoration of inefficient cardiac vagal regulation or autonomic control, (2) alterations in intestinal microbial pathways, and (3) neuromodulation of the limbic system, previously demonstrated in a preclinical study 16,17,39,40 . Multiple, conjoined mechanisms may also be at play and more studies of pathophysiology and long‐term effects of PENFS are needed.…”

“…Other proposed PENFS mechanisms to some degree supported by data include: (1) restoration of inefficient cardiac vagal regulation or autonomic control, (2) alterations in intestinal microbial pathways, and (3) neuromodulation of the limbic system, previously demonstrated in a preclinical study. 16,17,39,40 Multiple, conjoined mechanisms may also be at play and more studies of pathophysiology and long-term effects of PENFS are needed. These data are suggestive that PENFS at least in part targets the gut-brain axis dysregulation of DGBI.…”

Transcutaneous vagus nerve stimulation: a new strategy for Alzheimer’s disease intervention through the brain-gut-microbiota axis?

“…Furthermore, VNS has been observed to improve intestinal barrier integrity, increasing intestinal villus height and expression of tight junction proteins ( Costantini et al, 2010b ). A study on adolescents with irritable bowel syndrome showed significant improvements in gut microbiota diversity following taVNS ( Bora et al, 2023 ). However, these findings have not been universally replicated.…”