da Silva ACA, Severo JS, dos Santos BLB, Soares HS, Martins JA, Lima RSP, Gadelha KKL, Torres-Leal FL, Correia-de-Sá P, Magalhães PJC, Santos AA, da Silva MTB. Role of physical exercise, vagal nerve stimulation, and vagotomy in inflammatory bowel disease. World J Gastroenterol 2025; 31(38): 111252 [PMID: 41112001 DOI: 10.3748/wjg.v31.i38.111252]
Reader's ID:
03769692
Submitted on:
October 20, 2025, 02:39
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Reader Comments:
This article provides a timely and valuable overview of emerging therapeutic strategies for managing IBD. The integration of physical exercise and VNS as adjuncts to traditional pharmacological treatments is particularly relevant, as clinicians are increasingly seeking non-invasive and complementary approaches to help manage chronic inflammatory diseases. The article does an excellent job of explaining how these interventions may improve autonomic regulation, reduce inflammation, and promote gut health, which are all essential factors in managing the symptoms and progression of IBD. The focus on the vagus nerve’s role in regulating the immune system through the cholinergic anti-inflammatory pathway presents an interesting potential for VNS as a therapeutic tool. The idea that VNS could restore normal immune function, protect the intestinal barrier, and improve the composition of the gut microbiota is compelling, especially for patients who do not respond adequately to conventional treatments. This could open new avenues for clinical practice, offering patients a holistic approach to managing IBD.
However, one of the challenges noted in the article is the variability in response to these non-pharmacological interventions. The review highlights how factors such as exercise intensity, duration, and individual patient factors can influence outcomes. This reflects a common issue in clinical practice, where personalized approaches are often required to determine the best intervention for a given patient. While the evidence for the benefits of physical exercise and VNS in IBD is promising, further studies are needed to establish standardized protocols and validate these therapies in diverse patient populations. The inclusion of vagotomy as a counterpoint to VNS and exercise also brings an important clinical consideration into focus. The article explains how vagotomy, by disrupting the vagal pathway, may exacerbate intestinal inflammation and worsen IBD symptoms. This serves as a reminder of the delicate balance between parasympathetic and sympathetic nervous system function and the potential risks of interfering with this balance in patients with chronic inflammatory conditions.