Noninvasive electrical neuromodulation for gastrointestinal motility disorders

ABSTRACT

Introduction

Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. noninvasive electrical neuromodulation is an emerging therapy for treating various gastrointestinal motility disorders.

Areas covered

In this review, several emerging noninvasive neuromodulation methods are introduced, including transcutaneous auricular vagal nerve stimulation, percutaneous auricular vagal nerve stimulation, transcutaneous cervical vagal nerve stimulation, transcutaneous electrical acustimulation, transabdominal interference stimulation, tibial nerve stimulation, and translumbosacral neuromodulation therapy. Their clinical applications in the most common gastrointestinal motility are discussed, including gastroesophageal reflux disease, functional dyspepsia, gastroparesis, functional constipation, irritable bowel syndrome, and fecal incontinence. PubMed database was searched from 1995 to June 2023 for relevant articles in English.

Expert opinion

Noninvasive neuromodulation is effective and safe in improving both gastrointestinal symptoms and dysmotility; it can be used when pharmacotherapy is ineffective. Future directions include refining the methodology, improving device development and understanding mechanisms of action.

KEYWORDS:

• Gastrointestinal motility disorder
• noninvasive neuromodulation
• electrical stimulation
• vagus nerve
• brain-gut axis

Article highlights

• Gastrointestinal motility disorders are highly prevalent without satisfactory treatment. Noninvasive electrical stimulation is an emerging therapy by indirectly stimulating relevant nerves from the surface skin.

• Noninvasive electrical stimulation has been shown to improve symptoms of a few major gastrointestinal motility disorders and ameliorating pathophysiologies, such as modulating gastrointestinal dysmotility by enhancing parasympathetic activity.

• It is recommended to optimize the stimulation parameter in treating gastrointestinal motility disorders, and to conduct multi-center clinical trials to establish the clinical efficacies of noninvasive electrical stimulation for gastrointestinal motility disorders.

• Mechanisms of brain-gut communication need to be further investigated.

Declaration of interests

J Yin is employed by Transtimulation Research Inc. that is devoted to developing novel neuromodulation therapies for treating various gastrointestinal disorders. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was partially supported by grants from the National Institutes of Health (AT011380 for J Yin; UH3NS115108 and DK131524 for J Chen).