Vagotomy linked with later risk for IBD
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Patients who underwent vagotomy were at greater risk for later development of inflammatory bowel disease, indicating the beneficial role of the vagal tone in IBD, according to research published in Alimentary Pharmacology & Therapeutics.
Bojing Liu, MSc, of the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden and colleagues wrote that the vagus nerve provides essential parasympathetic innervation to the gastrointestinal tract.
“Although somewhat debatable, evidence suggests that the vagus nerve has anti-inflammatory properties through both efferent and afferent fibers,” they wrote. “Vagal neuromodulation is suggested to up-regulate the cholinergic anti-inflammatory pathway, which has a protective effect on systemic and local intestinal inflammation.”
Researchers explored the relationship between vagotomy and subsequent risk for IBD by matching 15,637 patients who underwent vagotomy with 40 control individuals each. They estimated hazard ratios for IBD adjusting for matching variables, year of procedure, birth country, chronic obstructive pulmonary disease and comorbidity index.
In the vagotomy group, 119 patients developed IBD (0.8%) compared with 3,377 individuals in the control group (0.5%). The vagotomy group had a higher incidence of IBD (0.38 per 1,000 person-years vs. 0.25 per 1,000 person-years).
Investigators observed a time-dependent, elevated risk for IBD associated with vagotomy (HR = 1.8; 95% CI, 1.4-6.8 at year 5 and HR = 1.49; 95% CI, 1.14-1.96 at year 10). The association was stronger for truncal than selective vagotomy and limited to Crohn’s disease (HR = 3.63; 95%, 1.94-6.8 for truncal; HR = 2.06: 95% CI, 1.49-2.84 for selective vagotomy) but not ulcerative colitis.
“Our findings of a positive association between vagotomy and later IBD strengthen the pivotal role of the autonomic nervous system in chronic inflammatory conditions within the gastrointestinal tract,” Liu and colleagues concluded. “The current findings are in accord with the concept of therapeutic vagal stimulation in IBD (especially CD) and indirectly emphasize the beneficial role of the vagal tone in IBD.”
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