Division of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou, China.
Division of Gastroenterology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Am J Physiol Gastrointest Liver Physiol. 2021 May 1;320(5):G700-G711. doi: 10.1152/ajpgi.00426.2020. Epub 2021 Feb 24.
This study was designed to investigate whether transcutaneous auricular vagal nerve stimulation (taVNS) would be able to improve major pathophysiologies of functional dyspepsia (FD) in patients with FD. Thirty-six patients with FD (21 F) were studied in two sessions (taVNS and sham-ES). Physiological measurements, including gastric slow waves, gastric accommodation, and autonomic functions, were assessed by the electrogastrogram (EGG), a nutrient drink test and the spectral analysis of heart rate variability derived from the electrocardiogram (ECG), respectively. Thirty-six patients with FD (25 F) were randomized to receive 2-wk taVNS or sham-ES. The dyspeptic symptom scales, anxiety and depression scores, and the same physiological measurements were assessed at the beginning and the end of the 2-wk treatment. In comparison with sham-ES, acute taVNS improved gastric accommodation ( = 0.008), increased the percentage of normal gastric slow waves (%NSW, fasting: = 0.010; fed: = 0.007) and vagal activity (fasting: = 0.056; fed: = 0.026). In comparison with baseline, 2-wk taVNS but not sham-ES reduced symptoms of dyspepsia ( = 0.010), decreased the scores of anxiety ( = 0.002) and depression ( < 0.001), and improved gastric accommodation ( < 0.001) and the %NSW (fasting: < 0.05; fed: < 0.05) by enhancing vagal efferent activity (fasting: = 0.015; fed: = 0.048). Compared with the HC, the patients showed increased anxiety ( < 0.001) and depression ( < 0.001), and decreased gastric accommodation ( < 0.001) and %NSW ( < 0.001) as well as decreased vagal activity (fasting: = 0.047). The noninvasive taVNS has a therapeutic potential for treating nonsevere FD by improving gastric accommodation and gastric pace-making activity via enhancing vagal activity. Treatment of functional dyspepsia is difficult due to various pathophysiological factors. The proposed method of transcutaneous auricular vagal nerve stimulation improves symptoms of both dyspepsia and depression/anxiety, and gastric functions (accommodation and slow waves), possibly mediated via the enhancement of vagal efferent activity. This noninvasive and easy-to-implement neuromodulation method will be well received by patients and healthcare providers.
这项研究旨在探讨经皮耳迷走神经刺激（taVNS）是否能够改善功能性消化不良（FD）患者的主要病理生理变化。将 36 名 FD 患者（21 名女性）分为 taVNS 和假刺激 ES 两组进行研究。通过胃电图（EGG）、营养饮料测试和心电图（ECG）的心率变异性频谱分析，分别评估生理测量，包括胃慢波、胃顺应性和自主功能。将 36 名 FD 患者（25 名女性）随机分为 2 周 taVNS 或假刺激 ES 组。在 2 周治疗开始和结束时，评估消化不良症状量表、焦虑和抑郁评分以及相同的生理测量。与假刺激 ES 相比，急性 taVNS 可改善胃顺应性（ = 0.008），增加正常胃慢波百分比（%NSW，空腹： = 0.010；进食： = 0.007）和迷走神经活动（空腹： = 0.056；进食： = 0.026）。与基线相比，2 周 taVNS 而非假刺激 ES 可减轻消化不良症状（ = 0.010），降低焦虑评分（ = 0.002）和抑郁评分（ < 0.001），改善胃顺应性（ < 0.001）和 %NSW（空腹： < 0.05；进食： < 0.05），增强迷走神经传出活动（空腹： = 0.015；进食： = 0.048）。与 HC 相比，患者表现出焦虑增加（ < 0.001）和抑郁增加（ < 0.001），胃顺应性降低（ < 0.001）和 %NSW 降低（ < 0.001）以及迷走神经活动降低（空腹： = 0.047）。非侵入性 taVNS 通过增强迷走神经传出活动，具有改善胃顺应性和胃起搏活动的治疗非严重 FD 的潜力。功能性消化不良的治疗较为困难，因为存在多种病理生理因素。所提出的经皮耳迷走神经刺激方法可通过增强迷走神经传出活动来改善消化不良和抑郁/焦虑以及胃功能（顺应性和慢波）的症状。这种非侵入性且易于实施的神经调节方法将受到患者和医疗保健提供者的欢迎。
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