Dong MQ, Wu J. Letter to the Editor: Gut-vascular barrier dysfunction in intestinal obstruction: The role of vagal suppression and heart rate variability. World J Gastrointest Surg 2026; 18(3): 116006 [DOI: 10.4240/wjgs.v18.i3.116006]
Corresponding Author of This Article
Jiong Wu, MD, Chief Physician, Professor, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, No. 110 Ganhe Road, Hongkou District, Shanghai 200437, China. tcmoctober9@163.com
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Gastroenterology & Hepatology
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Correspondence
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Mar 27, 2026 (publication date) through Mar 30, 2026
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Dong MQ, Wu J. Letter to the Editor: Gut-vascular barrier dysfunction in intestinal obstruction: The role of vagal suppression and heart rate variability. World J Gastrointest Surg 2026; 18(3): 116006 [DOI: 10.4240/wjgs.v18.i3.116006]
World J Gastrointest Surg. Mar 27, 2026; 18(3): 116006 Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.116006
Letter to the Editor: Gut-vascular barrier dysfunction in intestinal obstruction: The role of vagal suppression and heart rate variability
Meng-Qing Dong, Jiong Wu
Meng-Qing Dong, Department of Proctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
Jiong Wu, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, Shanghai 200437, China
Author contributions: Dong MQ wrote the original draft; Wu J contributed to conceptualization, writing, reviewing and editing; Dong MQ and Wu J participated in drafting the manuscript; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Jiong Wu, MD, Chief Physician, Professor, Department of Coloproctology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of TCM, No. 110 Ganhe Road, Hongkou District, Shanghai 200437, China. tcmoctober9@163.com
Received: October 31, 2025 Revised: November 21, 2025 Accepted: January 19, 2026 Published online: March 27, 2026 Processing time: 147 Days and 21.9 Hours
Abstract
We read with great interest the study by Zhang et al in the World Journal of Gastrointestinal Surgery which presents the first human evidence linking intestinal obstruction to gut-vascular barrier (GVB) injury, as demonstrated by elevated levels of plasmalemma vesicle associated protein 1 (PV1). This letter proposes that autonomic imbalance - specifically, suppressed vagal tone, reflected by reduced heart rate variability (HRV) - may represent a key mechanistic link between intestinal obstruction and GVB disruption. Decreased vagal activity may aggravate intestinal inflammation and barrier dysfunction, thereby perpetuating a harmful feedback loop. We recommend investigating the associations among HRV, PV1 expression, and GVB integrity. Integrating HRV and PV1 measurements may support the development of prognostic markers and guide potential therapeutic approaches, such as vagus nerve stimulation, to protect the GVB and improve clinical outcomes.
Core Tip: This article highlights a potentially overlooked mechanism - the role of the autonomic nervous system, particularly vagal tone, which may serve as a critical connection between intestinal obstruction and gut-vascular barrier disruption. Future research should investigate the link between heart rate variability and plasmalemma vesicle associated protein 1 expression, as integrating this non-invasive measure with a molecular marker could improve prognostication and reveal novel therapeutic avenues, such as vagus nerve stimulation.
