Role of physical exercise, vagal nerve stimulation, and vagotomy in inflammatory bowel disease

Inflammatory bowel disease (IBD), comprising Crohn's disease and ulcerative colitis, represents the two predominant clinical entities within this spectrum of gastrointestinal disorders. Current evidence indicates that the etiology of IBD is multifactorial, involving a complex interplay between host genetic susceptibility and environmental determinants. In recent years, non-pharmacological strategies such as physical exercise and vagus nerve stimulation have gained increasing attention as adjunctive therapeutic approaches. Vagus nerve stimulation has emerged as a promising therapeutic modality, particularly in conditions characterized by autonomic dysfunction and diminished vagal tone. Conversely, vagotomy, by disrupting vagal control, abolishes parasympathetic reflexes and may potentiate inflammatory responses and exacerbate IBD symptomatology under stress conditions. Physical exercise has likewise been investigated as a non-pharmacological intervention in Crohn's disease and ulcerative colitis. Although the precise mechanisms remain to be fully elucidated, accumulating evidence suggests that skeletal muscle contractions promote the secretion of myokines, with recognized anti-inflammatory properties. These myokines act on the intestinal microenvironment, conferring protection against malignant transformation and modulating the composition and function of the gut microbiota. In this review, we critically examine the interplay between physical exercise, vagus nerve stimulation, and vagotomy in the pathophysiology and management of IBD, with particular emphasis on their immunomodulatory and therapeutic potential.