Rediscovering the Wanderer: restoration of sympathico-vagal disbalance in irritable bowel syndrome by neuromodulation – a novel therapeutic concept

Introduction

Common colloquial phrases like ‘gut feeling’ or ‘butterflies in my belly’ are not just idioms but reflect on the unique communication between gut and brain. The principal interface for this interaction is the autonomic nervous system — a largely subconscious system that manages bodily functions through a delicate balance between its two branches: the sympathetic and parasympathetic nervous systems.

Vagus Nerve and Chronic Pain

The vagus nerve is the main component of the latter. Diminished vagal tone resulting in increased sensitivity to pain is characteristic of many chronic pain disorders, including irritable bowel syndrome (IBS). People with IBS have frequent and often severe abdominal pain.

Understanding IBS

While its etiology remains poorly understood, IBS is now assumed to be caused by a malfunctioning of the gut–brain axis, often manifesting in sympathetico–vagal disbalance. However, no established therapies currently target this neurological disturbance.

Hypothesis and Approach

I hypothesize that restoring the sympathico–vagal disbalance through autonomic neuromodulation can be an important novel therapeutic target in IBS. To achieve this, I will use transcutaneous electrical vagus nerve stimulation via the auricular nerve.

Development of Vagal-Autonomic Neurosignature

I will also develop a novel multimodal ‘vagal-autonomic neurosignature’ through combining actively and passively recorded biometrics and high-power field neuroimaging. This profile will allow identification of patients who could benefit from the new treatment approach.

Mechanisms of Action

Simultaneously, I will investigate mechanisms of action in a comprehensive manner, using experimental models and tools I have previously developed.

Expected Impact

My project is foreseen to fundamentally change the therapeutic landscape of IBS and other pain disorders by providing high-quality clinical and mechanistic evidence for the efficacy of vagal neuromodulation. Identifying a neurological signature of patients that likely benefit from this approach would represent a major breakthrough in individualizing therapeutic efforts in IBS.