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Electrical vagus nerve stimulation as an innovative treatment in inflammatory bowel diseases

      The vagal cholinergic anti-inflammatory pathway involves the inhibition of pro-inflammatory cytokines release. Our previous studies revealed firstly, a blunted vagus nerve activity in Crohn’s Disease (CD) patients and secondly, an improvement of colitis in rats after electrical vagus nerve stimulation (eVNS). Consequently, a clinical eVNS study was performed in CD patients (Clinical Trials.gov NCT01569503). The main goal was to evaluate the safety and efficacy of this innovative treatment. Six CD patients under intestinal active inflammation were included and equipped with a vagal nerve stimulation device (Cyberonics Inc.). Stimulation parameters were 10 Hz, 500 μs, 0,5 mA, 30 s ON, 5 min OFF. Three main types of markers were measured during a one-year follow-up: clinical (Crohn’s disease activity index –CDAI-), biological (C-reactive protein-CRP-) and autonomic (heart rate variability-HRV-). Currently, the study is still running and only the six first month of follow-up are presented herein. Four patients have an improvement of 1) their clinical state marked by a decrease in CDAI, 2) their parasympathetic tone (HRV) which returns to an homeostatic level, 3) their biological state by a decrease in CRP. No adverse effect of eVNS was observed. In conclusion, these results show for the first time that eVNS in CD patients is safe and well tolerated. Moreover, long-term eVNS induces an effective improvement over the six first month and further next results will show us if this improvement is maintained over the one year follow-up. eVNS, devoided of problem of compliance, could be of interest as an alternative to classical pharmacological therapies.
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