Vagus nerve neuromodulation: A promising method for treating gastrointestinal dysmotility

Abstract

Zhang et al delivered a paradigm-shifting understanding of electroacupuncture (EA)’s action in diabetic gastroparesis through a well-defined vagal pathway. Their work bridged traditional acupuncture and modern neurogastroenterology, highlighting EA as a viable strategy for refractory diabetic gastroparesis. The study integrated electrophysiology (gastric slow-wave recordings), functional assays (phenol red gastric emptying, and intestinal propulsion), dynamic positron emission tomography/computed tomography imaging, histopathology, and molecular biology (Western blot, immunofluorescence, and enzyme-linked immunosorbent assay). This comprehensive approach robustly confirmed EA’s efficacy in restoring gastric motility, interstitial cells of Cajal function, and neuropeptide balance. Future studies should prioritize clinical translation and explore synergies with pharmacological agents.

Keywords: Electroacupuncture; Gastroparesis; Vagus nerve; Gastric motility; Neuromodulation

Core Tip: The study by Zhang et al offers compelling mechanistic insights into how electroacupuncture at the stomach 36 (Zusanli) acupuncture point improves gastric dysmotility in diabetic gastroparesis via the nucleus tractus solitarius-vagal axis. This work significantly advances the understanding of acupuncture’s neuromodulatory effects, providing a scientific foundation for non-pharmacological management of diabetic gastroparesis. The authors identified a peripheral-to-central pathway: Electroacupuncture at the stomach 36 activated cholinergic targets, specifically choline acetyltransferase and the alpha 7 nicotinic acetylcholine receptor. This activation initiated signal transmission through spinal afferents in the L4 to L6 segments of the spinal cord, which were then integrated within the nucleus tractus solitarius, resulting in vagal efferent modulation of gastric targets.