Non-invasive neuromodulation: an emerging intervention for visceral pain in gastrointestinal disorders

Abstract

Gastrointestinal (GI) disorders, which extend from the esophagus to the anus, are the most common diseases of the GI tract. Among these disorders, pain, encompassing both abdominal and visceral pain, is a predominant feature, affecting the patients’ quality of life and imposing a substantial financial burden on society. Pain signals originating from the gut intricately shape brain dynamics. In response, the brain sends appropriate descending signals to respond to pain through neuronal inhibition. However, due to the heterogeneous nature of the disease and its limited pathophysiological understanding, treatment options are minimal and often controversial. Consequently, many patients with GI disorders use complementary and alternative therapies such as neuromodulation to treat visceral pain. Neuromodulation intervenes in the central, peripheral, or autonomic nervous system by alternating or modulating nerve activity using electrical, electromagnetic, chemical, or optogenetic methodologies. Here, we review a few emerging noninvasive neuromodulation approaches with promising potential for alleviating pain associated with functional dyspepsia, gastroparesis, irritable bowel syndrome, inflammatory bowel disease, and non-cardiac chest pain. Moreover, we address critical aspects, including the efficacy, safety, and feasibility of these noninvasive neuromodulation methods, elucidate their mechanisms of action, and outline future research directions. In conclusion, the emerging field of noninvasive neuromodulation appears as a viable alternative therapeutic avenue for effectively managing visceral pain in GI disorders.

The gut microbiome in disorders of gut–brain interaction

“… 312 The results of this study prompted the hypothesis that auricular VNS decreases inflammation by activating the cholinergic anti-inflammatory pathway and, in turn, alleviating visceral pain. 312 , 313 This hypothesis is supported by a recent animal study reporting that VNS improves visceral sensitivity, depression, and inflammatory mediators via the a7nAChR-mediated inflammatory pathway in a mouse model of IBS. 314 Likewise, auricular percutaneous electrical nerve field stimulation (aPENFS), believed to target the vagus nerve, has demonstrated encouraging outcomes in mitigating visceral sensitivity and abdominal pain in three clinical trials involving adolescent IBS patients.…”

Small Intestinal Bacterial Overgrowth in Various Specialties of Medical Practice (Literature Review and Expert Council Resolution)

“…Изменение цитокинового профиля при СИБР нарушает целостность слизисто-эпителиального барьера ЖКТ у пациентов с СРК и предрасполагает к бактериальной транслокации; формируется порочный круг нарушения кишечной проницаемости и воспаления кишечной стенки, что ведет к развитию локального воспаления [32]. Сохраняющееся воспаление стенки кишки приводит к избыточной дегрануляции тучных клеток с высвобождением гистамина, который активирует висцеральные сенсорные нейроны, что приводит к повышению их возбудимости и формирует висцеральную гиперчувствительность [33].…”