Role of physical exercise, vagal nerve stimulation, and vagotomy in inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD), comprising Crohn’s disease and ulcerative colitis, represents the two predominant clinical entities within this spectrum of gastrointestinal disorders. Current evidence indicates that the etiology of IBD is multifactorial, involving a complex interplay between host genetic susceptibility and environmental determinants. In recent years, non-pharmacological strategies such as physical exercise and vagus nerve stimulation have gained increasing attention as adjunctive therapeutic approaches. Vagus nerve stimulation has emerged as a promising therapeutic modality, particularly in conditions characterized by autonomic dysfunction and diminished vagal tone. Conversely, vagotomy, by disrupting vagal control, abolishes parasympathetic reflexes and may potentiate inflammatory responses and exacerbate IBD symptomatology under stress conditions. Physical exercise has likewise been investigated as a non-pharmacological intervention in Crohn’s disease and ulcerative colitis. Although the precise mechanisms remain to be fully elucidated, accumulating evidence suggests that skeletal muscle contractions promote the secretion of myokines, with recognized anti-inflammatory properties. These myokines act on the intestinal microenvironment, conferring protection against malignant transformation and modulating the composition and function of the gut microbiota. In this review, we critically examine the interplay between physical exercise, vagus nerve stimulation, and vagotomy in the pathophysiology and management of IBD, with particular emphasis on their immunomodulatory and therapeutic potential.

Keywords: Physical exercise; Vagus nerve stimulation; Subdiaphragmatic vagotomy; Inflammatory bowel disease; Crohn’s disease; Ulcerative colitis

Core Tip: The vagus nerve plays a central role in gut-brain communication and the modulation of gastrointestinal inflammation through the cholinergic anti-inflammatory pathway. In this review, we explore the distinct and complementary effects of physical exercise, vagal nerve stimulation, and vagotomy in inflammatory bowel disease. While physical exercise emerges as a non-pharmacological strategy capable of enhancing vagal tone and releasing anti-inflammatory myokines, vagal nerve stimulation offers direct neuromodulation of immune responses and mucosal integrity. In contrast, vagotomy disrupts parasympathetic signaling and exacerbates intestinal inflammation. Understanding how these interventions impact the vagus nerve and immune homeostasis provides insight into novel therapeutic approaches for inflammatory bowel disease management.