Cervical spine instability and digestive disorders: Indigestion and irritable bowel syndrome caused by cervical spondylosis
Ross Hauser, MD
Can neck pain cause Inflammatory Bowel Disease and Irritable Bowel Syndrome?
In this article, I will offer a connection between cervical spine instability and digestive disorders.
Very often people will contact us at our center and they will tell us their story of some type of neck injury and the development of digestive-like symptoms. In most of these people digestive-like symptoms are only part of the large cache of problems they are dealing with but for some these digestive issues are very impactful on their lives.
It started with a car accident
I was in a car accident. The accident caused me to have disc herniation in my neck and lower back. I have developed chronic dizziness and lightheadedness, brain fog, balance issues, ear pain and fullness, neck pain, and stiffness. My neck problems cause me to feel like I have a very heavy head and sometimes I need to prop my head up with my hands or wear a stiff neck brace.
I have terrible GI issues, GERD, indigestion, I have very few, even rare bowel movements. This is more than regular constipation. I also have trouble swallowing. I have had numerous tests, angiograms, endoscopy, GI CT scans, and everything comes back “normal” except the herniated discs on MRI. I wish there was a test to measure how depressed and miserable I am.
I have had digestive issues for years – my long search for food sensitives and food allergies led me to a neck explanation
Over time I developed what was thought to be food allergies and food sensitivities which caused what I thought was a severe reaction to certain foods. I had difficulty swallowing, my throat would close up, I would get lightheaded and nearly pass out.
My doctors were looking to treat me for food allergies but they could not come up with anything. A change in my diet and nutritional supplementation seemed to help initially but as I was managing my diet I started to develop problems with dizziness, neck pain, and spasms, I could not move my head up and down. My neck problems were treated as something separate from my digestive problems. However, my abdominal problems worsened and my gastroenterologists began treating me for gastroparesis.
Then something happened. I was given a neck brace to help with my neck problems. Suddenly my symptoms started getting better. In my own research, I found out that I may have vagus nerve issues and I am trying to get this confirmed by a neurologist. I hope I can find one enlightened enough not to immediately suggest that there is really nothing wrong with me.
I am just trying to manage my Ehlers-Danlos syndromes
At our center, we see many patients with Ehlers-Danlos syndromes or hEDS (hypermobile type Ehlers-Danlos syndromes or joint hypermobility syndrome). Digestive problems are part of the symptomology of hypermobile type Ehlers-Danlos syndromes. We often find that the joint instability that they suffer in their neck can lead to compression of the spinal cord, vital arteries and veins, and their nervous system with a focus on the Vagus Nerve. This is explained below.
I am on a liquid diet
I have been diagnosed with hypermobile Ehlers-Danlos syndrome. While I have chronic pain throughout my body, my neck is the main concern. I have difficulty swallowing and choking on my food. I am on a liquid diet and have seen many specialists with no help. My many medical tests all come back “normal.”
I have lots of digestion issues and stomach pain
I have hypermobile Ehlers-Danlos syndrome, neck pain, lots of digestion issues, and stomach pain.
Let’s get to the research and clinical observations. Summary discussion points of this article.
- In brief, a cause of ulcerative colitis and Crohn’s Disease can be a malfunctioning immune system, caused by compression on the vagus nerve at the cervicl spine, causing runaway inflammation in the intestines.
- The vagus nerve is a critical link in understanding inflammatory bowel disease.
- Symptom: Depression and anxiety Learning more about the enteric nervous system.
- To offer an explanation of one possible cause for functional dyspepsia (indigestion) and irritable bowel syndrome caused by cervical spondylosis.
- A patient case: Cervical spine instability at C5-C6 causing a myriad of symptoms including GERD gastroesophageal reflux disease.
- Digestion & the Vagus Nerve: Sphincter function and related symptoms affected by neck instability.
- Vagus nerve and digestion.
- Mice with gastrointestinal problems – a connection is made between stress and the vagus nerve.
- Gastrointestinal symptoms and vagus nerve compression.
- So how do we treat a patient like this and how do we determine if these problems are from a vagus nerve compression in the neck?
- Treating cervical ligaments with Prolotherapy – published research from Caring Medical.
- In this video, DMX displays Prolotherapy before and after treatments.
- Further reading: Cervical Spine Realignment and restoring loss of cervical lordosis.
- Further reading: Symptoms and conditions of Craniocervical Instability.
In brief, a cause of ulcerative colitis and Crohn’s Disease can be a malfunctioning immune system, caused by compression on the vagus nerve at the cervicl spine, causing runaway inflammation in the intestines.
Inflammatory bowel disease comprises two main disorders: ulcerative colitis and Crohn’s Disease. Symptoms are characterized by abdominal pain, diarrhea, fever, weight loss and extraintestinal (skin, eyes, joints) manifestations. With ulcerative colitis the main symptom is diarrhea often accompanied by rectal bleeding, where in Crohn’s disease diarrhea, abdominal pain and weight loss are more common.
What distinguished Inflammatory bowel disease from inflammatory responses seen the normal gut is an inability to downregulate inflammatory responses. Thus, in individuals with inflammatory bowel disease inflammation is not downregulated, the mucosal immune system remains chronically activated, and the intestine remains chronically inflamed. During inflammation, proinflammatory cytokines (IL-1B, IL-6, TNF-a) released from intestinal mucosa activate vagus nerve afferents. In Inflammatory bowel disease the vagal anti-inflammatory system is not working correctly.
In brief, a cause of ulcerative colitis and Crohn’s Disease can be a malfunctioning immune system, caused by compression on the vagus nerve at the cervicl spine, causing runaway inflammation in the intestines.
In the image below: The types of ulcerative colitis – proctitis, distal colitis, pancolitis, proctosigmoiditis, subtotal colitis.
The vagus nerve is a critical link in understanding inflammatory bowel disease
What are neural reflexes? These are involuntary reflexes, the things you do not have to think about such as the path of food down the digestive tract and the nerve message the body sends to digest and process this food. These neural reflexes are managed and maintained in the enteric nervous system (ENS) which is responsible for coordinating most ongoing activities of the GI tract, such as patterns of motility, secretions and local blood flow. Although the enteric nervous system (ENS) can operate the digestive functions of the body without input from the central nervous system, it does not normally do so; the central nervous system influences enteric behavior. One bad influence may come from a problem of disease in the central nervous system. This problem can lead to dysfunction of the gut. Vagus nerve compression can be considered one of these problems interfering with proper digestion. The ease of which dysfunction can occur with neural breakdown is seen in the fact that 90% of vagal fibers (nerve fibers that have their origins in the intestines) between the gut and the brain are afferent (receive messages), suggesting that the brain is more of a receiver than a transmitter with respect to brain-gut communication. Obviously the gut-to-brain signaling transmits sensation of nausea, bloating, hunger or satiety. In other words the nerve messages travel from intestine to brain to relay up to the minute information on the progresses of digestion and the possible problems of malabsorption and inflammation.
Symptom: Depression and anxiety
The caption reads: The role of vagus nerves on increasing hormone production in the gastrointestinal tract vagal stimulation or high vagal tone causes an enormous amount of hormones to be produced in the body for instance 90% of the serotonin the happiness hormone in the body is made in the gut.
One of the aspects we see in patients and as described above and in the videos below are the problems of depression and anxiety. Depression and anxiety issues helps demonstrate that problems in the bowel, irritable bowel disease, colitis, Crohn’s disease can have a neurological connection to compression of the vagus nerve in the cervical spine.
In June of 2022, Doctors from Aalborg University in Denmark, the Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York and at Massachusetts General Hospital and Harvard Medical School collaborated to discuss the connection between inflammatory bowel disease and the vagus nerve with anxiety and depression symptoms being a key. Here is what they wrote in the journal Nature reviews. Gastroenterology & hepatology. (14)
“Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, is a chronic, relapsing immune-mediated disease with a varying and sometimes severe disease course. Inflammatory bowel disease is often diagnosed in early adulthood and can lead to a substantial decline in quality of life. It has been suggested that patients with inflammatory bowel disease are at increased risk of depression and anxiety.”
In this paper the researchers sought to show a connection, if one existed. Here they make a suggestion:
“the possible mechanisms underlying the co-occurrence of inflammatory bowel disease and depression and anxiety, which include changes in brain signaling (the messages back and forth from brain to organs) and morphology (the systems that makes the messaging work and the breakdown that disturbs the messaging network), increases in peripheral and intracerebral pro-inflammatory cytokines (inflammatory proteins within the brain), impairment of the nitric oxide pathway (which facilitates blood flow among other functions), changes in vagal nerve signaling, gut dysbiosis and genetics.”
An earlier 2020 paper from researchers at Yale University described vagal nerve signaling as the ability of the vagus nerve to function correctly as: “The vagus nerve is a critical link between gut signals and the brain regulating various functions such as energy homeostasis, digestion, immune responses, reward, memory, and cognition.”(15)
What are we seeing in this image? Vagal neurogastroenterology.
The vagus nerves are crucial for optimum digestion and intestinal health. A further explanation of this image is given just below it.
What are we seeing in the above image?
Messages back and forth from the brain centers in frontal, somatomoto sensory, insular cortex, and hypothalamus regulated by the vagus afferents (bringing messages in) and vagal efferents (sending messages out) that help regulate the digestive tract. Via the enteric nervous system (ENS) the following functions are maintained:
- Increased intestinal motility.
- Sphincter contraction.
- Stomach acid and digestive enzyme release.
- Blood flow to digestive tract stimulation
This should all lead to proper food breakdown, absorption, and elimination of waste products.
Learning more about the enteric nervous system
In the image below we see on one side a health gut-brain axis that helps maintain normal emotions, immune tolerance, normal gut microbiota, and an intact gut barrier. On the other side we see the characteristics of a stressed gut-brain axis. Depression and anxiety, immune system overactivation (as seen in irritable bowel diseases), Dysbiosis (a gut imbalance of bacteria), and barrier dysfunction which can lead to problems to include Leaky Gut Syndrome.
The gut is a complicated organ. It is innervated by the enteric nervous system (ENS). The enteric nervous system (ENS) is a network of neurons and glia (glial cells insulate the neurons and keep the neurons in a comfortable environment) that controls ongoing gastrointestinal functions. Damage or injury to the ENS can lead to functional GI disorders including irritable bowel syndrome and inflammatory bowel disease.
As we have seen, numerous scientific studies support the conclusion that many functional GI disorders are caused by an imbalance between gut microbes and the immune system. The vagus nerve has been shown to be critical in the communication of the microbiome (the microbes of the gut) with the central nervous system. The gut-associated lymphoid tissue (gut-associated immune system) contains two-thirds of the body’s immune cells with thousands of enteroendocrine cells (hormone-producing cells in the gut epithelium) containing more than 20 identified hormones. To better understand this, lets refer to a 2019 paper (18) from researchers at the Institute of Metabolic Science, Addenbrooke’s Hospital, Cambridge, UK.
“Gut hormones have many key roles in the control of metabolism, as they target diverse tissues involved in the control of intestinal function, insulin secretion, nutrient assimilation and food intake. Produced by scattered cells found along the length of the intestinal epithelium, gut hormones generate signals related to the rate of nutrient absorption, the composition of the luminal milieu and the integrity of the epithelial barrier (holes in which lead to leaky gut syndrome).”
The enteroendocrine cells therefore are responsible for:
- Ingested food regulating, in addition to digestive functions, energy balance. To this end it should be noted that accumulating evidence (As we will discuss below) suggests that the brain-gut interaction is a bidirectional vagus highway In the image above this is:
- Increased intestinal motility.
- Sphincter contraction.
- Stomach acid and digestive enzyme release
- Blood flow to digestive tract stimulated
Because of the enteroendocrine cells and bacteria and other foreign antigens (including genetically modified foods) in the GI tract float closely together, it is important to prevent the passage of these antigens through the GI epithelium (the gut barrier). If any foreign compounds manage to pass through the GI epithelium (so-called leaky gut syndrome), an immune response is triggered (as 80% of a persons immune system is in the GI tract) to prevent injury to the ENS and underlying structures.
If the inflammation goes unchecked, not only can ulcerative colitis or Crohn’s disease form but also autoimmune diseases. Enteric neurons and glial cells are capable of modulating immune functions in these situations if they are functioning normally. It is important to remember that the GI tract harbors the most immune cells in the body. So it will be one of the first places to show effects, if inflammation is getting out of control in the body. The extremes are gastrointestinal inflammation is seen inflammatory bowel disease.
Equaling: Proper food breakdown absorption and elimination of waste products.
To offer an explanation of one possible cause for functional dyspepsia (indigestion) and irritable bowel syndrome caused by cervical spondylosis
We are going to start this section, where I will offer a connection between cervical spine instability and the problems of irritable bowel disease with the image below. The caption reads: Innervation and interactions between nervous and immune system in the intestine. To the left in the A panel, sympathetic (red) and vagal (blue) innervation of the small and large intestine. In the right side panel B, Vagal inputs (blue) solely innervate myenteric neurons (gut-brain communication neurons). Since 90% of the immune system is in the gut, ligamentous cervical instability (neck instability) causing vagopathy (dysfunction of the vagus nerve communications) can drastically alter immune function.
Making a connection between the cervical spine and irritable bowel disease
In 2007, a study was published in the World Journal of Gastroenterology (1) from a research team that wanted “to offer an explanation of one possible cause for functional dyspepsia (indigestion) and irritable bowel syndrome caused by cervical spondylosis.” In this study, the research team used laboratory rats who had surgically induced cervical instability at the C4-C6 levels. As a result, the researchers noted that in both the spinal cord and the stomach, there were elevated inflammatory markers including c-Fos protein, an indicator of nerve inflammation that has been associated with problems of irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and Crohn’s disease.
It should also be noted that elevated levels of c-Fos protein are associated with gastrointestinal distress and TMJ syndrome – jaw pain as noted in a 2014 study in The Journal of Pain: Official Journal of the American Pain Society (2) which stated: “The majority of patients with temporomandibular disorder report symptoms consistent with irritable bowel syndrome.” Please see our article: The evidence for TMJ injections into the jaw and cervical spine, for the many connections between TMJ and cervical neck pain.
Returning to the first study, the researchers here titled their paper: “A preliminary study of the neck-stomach syndrome,” because they believed they could demonstrate that neck problems gave you stomach problems. Just about every day we get phone calls or emails from people with cervical spine instability and neck problems who can also demonstrate that neck problems gave them stomach problems. One more area that I will touch on later in this video summary article is the involvement of vagus nerve compression in the cervical spine on the digestive cycle.
Citing the 2007 research above, a team of international researchers from the University of Geneva, the University of Cincinnati College of Medicine, the University of Toronto, the University of Tokyo, Kerman University of Medical Sciences, and Yale University wrote in February 2020 in the Journal of Clinical Medicine (8) about the challenges presented in people over the age of 50 who have degenerative cervical myelopathy and digestive complaints. In this study, the researchers, on trying to isolate problems of cervical spine disease and gastrointestinal disorders, could not come to a firm conclusion of a connection in older patients. This is what they said:
“Degenerative cervical myelopathy is the most common cause of spinal cord impairment in adults, presenting most frequently in patients 50 years or older. Gastrointestinal comorbidities (Gastrointestinal distress as a co-symptom) commonly occur in this group; however, their relationship with degenerative cervical myelopathy has not been thoroughly investigated.
Degenerative cervical myelopathy patients with Gastrointestinal comorbidities are more likely to be female and have significantly more general health impairment and neck disability. However, these patients have fewer clinical and MRI features typical of more severe neurological impairment. This constellation of symptoms is considerably different than those typically observed in degenerative cervical myelopathy, and it is therefore plausible that nutritional factors may contribute to this unique observation.”
What the researchers are saying is that the women of this study did not have a more severe MRI that would indicate a neurological impairment (nerve impingement) and it is possible that the nutritional disorders were a separate product of poorer general health.
“Patients with Gastrointestinal comorbidities represent a unique (group) that is different from typical Degenerative cervical myelopathy patients: (1) they are more commonly female, (2) almost a third of patients have psychiatric comorbidities, and (3) they have worse general health and (nutritional deficiency) findings.”
Let’s finish with the researcher’s summary where they suggest that there are findings still to be found:
“A clear limitation to this study is the nonspecific nature of having classified patients into a single group of gastrointestinal comorbidities. It would have been preferable to know specific diagnoses; (what type of digestive disorders they suffered from) however, these data were not available. Furthermore, given that the main study was not focused on gastrointestinal disease, we may have not captured an accurate population prevalence. Due to this, caution needs to be taken in interpreting the results, as false-positive relationships are possible. Further, we have hypothesized that the unique differences observed here are possibly due to nutritional deficiencies; however, further work is needed to corroborate this. Lastly, because MRI data were derived from multiple global sites, there was no standardized protocol used to obtain MRIs.”
In my article Emotional stress: Anxiety, Depression and Panic Attacks: A neurologic and psychiatric-like condition caused by cervical spine instability I discuss patients who have been battling general poor health for many years and the emotional burden that comes with it. I discuss research that suggests emotional stress is something more than “illness fatigue,” and that there can be an anatomic explanation that may not be easily found.
Are the neck problems causing problems with the patient’s desire to eat?
The question can also be asked, is the neck problems causing problems with the patient’s desire to eat, or are the neck problems causing other health concerns that can lead to poorer general health.
Diarrhea, constipation, feeling full after eating very little (early satiety), swallowing difficulties, decreased or increased salivation, gastroparesis, fainting during toileting activities, increased gastric motility, excessive gas, vomiting and extreme nausea can signify gastrointestinal manifestations of autonomic dysfunction. Dysautonomia, a marker of brain-gut dysfunction, involves a high sympathetic and a low parasympathetic tone, and is characteristic of irritable bowel and inflammatory bowel syndrome, irrespective of positive or negative emotions. As noted in a paper in the journal Psychoneuroendocrinology (16) these symptoms and conditions are commonly reported in patients with cervical instability.
A patient case: Cervical spine instability at C5-C6 causing a myriad of symptoms including GERD gastroesophageal reflux disease
Video summary and explanatory notes:
The video begins: This particular patient is middle age, she’s one of my many Ehlers-Danlos syndrome patients and her symptoms gradually came on. Over the course of years, she has seen many doctors, gastroenterologists, ENTs, neurologists, pain doctors, etc. She has had the gradual onset of ringing in the ears, tinnitus, migraines, fainting spells, loss of balance, speech issues, voice issues, and interesting to me is GERD or gastroesophageal reflux disease and other digestive problems.
(At 1:15 of the video) On the initial assessment we did a DMX (Digital Motion X-Ray) and this revealed many interesting points.
- In this first point of interest, we see that the disc heights at the C2/C3 vertebrae, the C3/C4 vertebrae, the C4/C5 vertebrae are completely normal.
- However, when we get to the C5/C6 (1:30 of the video presentation) you see there’s almost no disc space. In addition her (See image below 1:47 of video) C5 vertebrae is offset and is now sliding backward out of place (posteriorly) and is developing a bone spur. We are going to see how this bone spur is going to narrow her spinal cord space.
The image at (1:47 of the video presentation describing the offset of the C5 vertebrae to the C6).
So what we see in her Digital Motion X-ray is that she has a lot of cervical spine instability at C5-C6 and her body has tried its best to try to stabilize the C5-C6 area by creating the bone spur. Had I seen her at the onset of her symptoms, she may have only needed one to three treatments of Prolotherapy (see treatments below) and none of these issues of C5-C6 instability, bone spurs, and other problems would have likely developed.
- At 2:20 of the video, the Digital Motion X-Ray shows the abnormal movement of the cervical spine.
- At 2:27 of the video, the patient’s “George’s Line” (or the Posterior Body Line all the vertebrae should line up in a good George’s line) demonstrates breaks or space in the line at C2, C3, C4, C5 indicating a cervical spine instability and cervical ligament laxity or damage.
- At 3:00 of the video, the patient DOES NOT HAVE vertebral instability at C5-C6 because of the presence of the bone spurs.
- At 3:08 of the video we are going to see on her extension view (with her head tilted backward, eyes pointing upwards) that is bone spur starts narrowing the spinal space and can compress on the spinal cord. This is the onset of cervical spinal stenosis. The spinal canal space can be narrowed by cervical ligament laxity or weakness in its normal strength allowing for unnatural hypermobility of the cervical vertebrae or this compression can occur because of bone spurs. In this patient’s case, she suffers from both cervical ligament laxity and the development of bone spurs on the vertebrae.
- At 3:50 of this video, with the patient in neck extension, the digital motion x-ray reveals the narrowing of the spinal canal space with this head back movement.
In this patient, we can get a lot of her symptoms better, including her GERD gastroesophageal reflux symptoms which I believe are from the vagus nerve not working correctly because of the instability by addressing her cervical ligament weakness and laxity. Again I explain this below.
Digestion & the Vagus Nerve: Sphincter function and related symptoms affected by neck instability. Can digestive issues be related to neck problems?
Ross Hauser, MD discusses digestion and the vagus nerve as it relates to the sphincter function. In the histories of patients who we see in our center, they often feel like they hit a wall with regard to finding resolution of symptoms or their digestion conditions because the focus has been too narrow. When looking at many digestive symptoms through the aspect of vagus nerve health, many times solutions can be found because the vagus nerve innervates many vital digestive organs. Thus, in our center, we find that patients who have digestive complaints as part of their constellation of symptoms that also point to vagus nerve impairment, that the upper cervical area and the cervical curve should be analyzed and examined to see if this could be the cause of the issues.
Vagus nerve and digestion
When a patient comes into our clinic for cervical spine instability issues and they describe digestive problems, the digestive difficulties are usually one of many symptoms, as I described above. One of the causes of this myriad of symptoms may be found in compression of the vagus nerve. We have two vagus nerves. The one on the left side of the neck and the one on the right side of the neck. Among the many functions of the vagus nerve is that it provides 75% of the total input for the parasympathetic nervous system, aptly called the rest and digest system. The vagus nerve is responsible for managing our intestinal activity as well as managing the sphincter muscles in the gastrointestinal tract.
Cervicovagopathic Inflammatory Bowel Disease and Irritable Bowel Syndrome
What most do not understand is that the vagus nerve is the body’s anti-inflammatory police patrol, especially as it relates to the gastrointestinal tract. The vagus nerve is involved in basically everything related to digestion. Signals travel from the gut lumen to the brain, via the vagus nerve. The vagus is the primary integrator of visceral sensory information, and vagal innervation of the gastrointestinal tract is critical to various homeostatis processes including satiety and visceral pain signally. (17)
As we have seen throughout this article and to summarize: Inflammatory bowel disease including ulcerative colitis and Crohn’s disease are chronic conditions of uncontrolled, runaway inflammation of the intestinal mucosa. It is this inflammation that can lead to the symptoms of abdominal pain, diarrhea, fever, weight loss, and extraintestinal (skin, eyes, joints) manifestations. With ulcerative colitis, the main symptom is diarrhea, often accompanied by rectal bleeding, wherein Crohn’s disease diarrhea, abdominal pain, and weight loss are more common.
Irritable bowel syndrome is not a basic gastroenterological disorder, but a complex disorder with contributions from brain structures
In a July 2020 study from gastroenterology specialists in Turkey, (11) recent studies have shown that Irritable bowel syndrome is not a basic gastroenterological disorder, but a complex disorder with contributions from brain structures, such as the cortex, amygdala (a brain structure known for “housing” emotions), hippocampus (where emotion, memory, and the autonomic nervous system center), anterior cingulate cortex (controlling emotion and mood), and insula (pain, addiction), as well as the hypothalamic–hypophysis axis and endocrine systems. . .The vagus nerve is one of the major transitways between the brain-gut axis. It is well known that vagus nerve efferent fibers (as mentioned throught this article, the network by which messages from the brain to the gut are sent) do not directly affect motor or secretory function of the gut, but affect the myenteric plexus. (The myenteric plexus (or Auerbach plexus) are the network of nerves between the layers of the muscular propria (the layers of smooth muscle that move food through the gut) in the gastrointestinal system. It is believed that parasympathetic efferents (the “calm down” messages of the nervous system) of the vagus nerve might be synapsing directly with enteric motor neurons – control the motor functions of the system, in addition to the secretion of gastrointestinal enzymes.)
What does all this mean? The vagus nerve does not send messages directly into the gut but to the enteric nervous system which tells the gut to move food down the line and facilitate this movement and digestion by the proper release of gastrointestinal enzymes. So we can already see that any messages between the vagus nerve and the enteric nervous system that get garbled, muffled, or simply drops out will cause the food in the digestive tract to stall and not be digested.
Psychiatric disorders and digestion. The inflammation connection.
OIrritable bowel diseases as mentioned numerous times are diseases of inflammation. An interesting study came out of Switzerland in 2018. (3) What makes this study interesting is that it was led by researchers in the University Hospital of Psychiatry, University of Bern. Specifically the Division of Molecular Psychiatry. Molecular Psychiatry seeks to uncover biological mechanisms underlying psychiatric disorders and their treatment. We see many patients with cervical spine instability who have been recommended to psychiatry. Here the research team presents the biological aspect, not the psychiatric aspect, of gastrointestinal disorders as related to the vagus nerve.
“The gastrointestinal tract is constantly confronted with food antigens, possible pathogens, and symbiotic intestinal microbiota that present a risk factor for intestinal inflammation. It is highly innervated by vagal fibers (vagus nerve) that connect the central nervous system with the intestinal immune system, making (the) vagus (nerve) a major component of the neuroendocrine-immune axis. This axis is involved in coordinated neural, behavioral, and endocrine responses, important for the first-line defense against inflammation.”
Above we see that the vagus nerve is shown responsible for fighting digestive tract inflammation.
The vagus nerve is able to sense the microbiota metabolites through its afferents, transfer this gut information to the central nervous system where it is integrated in the central autonomic network and then generate an adapted or inappropriate response. Stress it is well known inhibits the vagus nerve and has deleterious effects on the gastrointestinal tract and on the microbiota, as many conditions including inflammatory bowel syndrome and irritable bowel disease are characterized by dysbiosis (more bad bacteria than good disrupting the natural balance).
In another 2018 study, this time from France published in the Frontiers in Neuroscience. (4)
“The microbiota (the collective name for bowel environment), the gut, and the brain communicate through the microbiota-gut-brain axis in a bidirectional way that involves the autonomic nervous system. . . The vagus nerve, because of its role in interoceptive awareness (gut stimulation that processes and digests foods), is able to sense the microbiota metabolites (the digestive metabolizers) through its afferents (sensory neurons), to transfer this gut information to the central nervous system where it is integrated into the central autonomic network, and then to generate an adapted or inappropriate response.”
“Stress inhibits the vagus nerve and has deleterious effects on the gastrointestinal tract and on the microbiota, and is involved in the pathophysiology of gastrointestinal disorders such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) which are both characterized by a dysbiosis (a gut imbalance). A low vagal tone has been described in IBD and IBS patients thus favoring peripheral inflammation (the creation of inflammation along the digestive tract).”
The message here is that if you can increase vagus nerve function, you can reverse the inflammatory process leading to digestive disorders.
Bioelectronic medicine – vagus nerve stimulation
A March 2021 paper in the journal Frontiers in neuroscience (12) wrote that stimulation of the vagus nerve can be used in the treatment of chronic inflammatory bowel diseases, represented by Crohn’s disease and ulcerative colitis where this cytokine plays a key role. Bioelectronic medicine, via vagus nerve stimulation, may have an interest in this non-drug therapeutic approach as an alternative to conventional drugs which are not devoid of side effects feared by patients.
A June 2021 study (13) in the journal International immunology, wrote: “The hallmark of inflammatory bowel diseases (IBD) is chronic intestinal inflammation with typical onset in adolescents and young adults. An abundance of neutrophils (immune cells) is seen in the inflammatory lesions, but adaptive immunity (Adaptive immunity involves new and specialized immune cells and antibodies that remembered what certain inflammatory or pathogen cells look and prepare themselves for the next invasion) is also an important player in the chronicity (long-term chronic impact of the disease. There is an unmet need for new treatment options since modern medicines such as biological therapy with anti-cytokine antibodies still leave a substantial number of patients with persisting disease activity. The role of the central nervous system and its interaction with the gut in the pathophysiology of IBD have been brought to attention both in animal models and in humans after the discovery of the inflammatory reflex. The suggested control of gut immunity by the brain-gut axis represents a novel therapeutic target suitable for bioelectronic intervention (such as a vagal nerve stimulator).
Mice with gastrointestinal problems – a connection is made between stress and the vagus nerve
A December 2019 study published in the journal Neurogastroenterology and Motility (5) lead by doctors at the Vagal Afferent Research Group, Centre for Nutrition and Gastrointestinal Disease, Adelaide Medical School, University of Adelaide discussed exacerbated functional dyspepsia symptoms and emotional stress
Here are the learning points
- Stress exposure is known to trigger and exacerbate functional dyspepsia symptoms.
- Stomach pain, bloating, belching, and nausea
- Increased gastric sensitivity to food is widely observed in functional dyspepsia patients and is associated with stress and psychological disorders.
- The mechanisms underlying the hypersensitivity are not clear. Gastric vagal afferents play an important role in sensing meal-related mechanical stimulation to modulate gastrointestinal function and food intake.
In this study, mice were subjected to stress. The had exacerbated functional dyspepsia symptoms. Gastric vagal afferents mechanosensitivity, which may contribute to gastric hypersensitivity in functional dyspepsia.
What are Gastric vagal afferents?
A paper in the Journal of Neuroscience Online (6) explains:
“Vagal afferents are an important neuronal component of the gut-brain axis allowing bottom-up information flow from the viscera (the internal gut organs) to the Central Nervous System. In addition to its role in ingestive behavior, vagal afferent signaling has been implicated modulating mood and affect, including distinct forms of anxiety and fear.”
In this study, the researchers used mice to add to the growing evidence suggesting vagus nerve-related signal disruption from organs to the brain in the dysregulation of emotional behavior.
Why are researchers suggesting these mice studies hold significant clues to the connection between vagus nerve dysfunction and gastrointestinal distress?
Kirsteen Browning of the Department of Neural and Behavioral Sciences, Penn State College of Medicine wrote in December 2019 in the journal Neurogastroenterology and Motility (9): “Vagally (Vagus nerve) dependent gastric functions, including motility, tone, compliance, and emptying rate, play an important role in the regulation of food intake and satiation. Vagal afferent fibers relay sensory information from the stomach, including meal-related information, centrally and initiate coordinated autonomic efferent responses that regulate upper gastrointestinal responses. . .
The remarkable degree of plasticity (the ability to adapt and change) with gastric vagal afferent neurons and fibers suggests that dysregulation of vagally-dependent sensory processing may play a prominent role in several gastrointestinal pathologies. Clinical studies have demonstrated that gastric hypersensitivity is associated with functional dyspepsia, the symptoms of which are known to be exacerbated by stress and food ingestion. (Research) demonstrate that, in a rodent model of chronic mild stress, the mechanosensitivity of gastric vagal afferents is increased significantly, which may provide a mechanistic (physically anatomical) basis for the gastric hypersensitivity observed in functional dyspepsia”
In Human studies
This research is making its way into human studies. This is a paper from Laurent Gautron from the Department of Internal Medicine, Center for Hypothalamic Research, The University of Texas Southwestern Medical Center. It was published in the journal Frontiers in Neuroscience in February 2021. (10)
“The excitation of vagal mechanoreceptors located in the stomach wall directly contributes to satiation (the sensation of fullness). Thus, a loss of gastric innervation would normally be expected to result in abrogated (aborted, not feeling full) satiation, hyperphagia (increased appetite), and unwanted weight gain.”
If the vagus nerves are mechanoreceptors damaged you may not know when you are really hungry or really full.
While (Gastric Bypass Surgery) inevitably results in gastric denervation, paradoxically, bypassed subjects continue to experience satiation. Inspired by the literature in neurology on phantom limbs, I propose a new hypothesis in which damage to the stomach innervation during (Gastric Bypass Surgery), including its vagal supply, leads to large-scale maladaptive changes in viscerosensory nerves and connected brain circuits. As a result, satiation (you think you need or do need more food to get to a feeling of fullness) may continue to arise, sometimes at exaggerated levels, even in subjects with a denervated or truncated stomach. The same maladaptive changes may also contribute to dysautonomia, unexplained pain, and new emotional responses to eating.”
Gastrointestinal symptoms and vagus nerve compression
In this video Ross Hauser, MD. discusses a myriad of gastrointestinal symptoms that may be caused by vagus nerve compression typically found in cervical spine instability.
Below is a summary transcript with explanatory notes:
- We see many patients with clicking, grinding, crunching in their necks. They have terrible migraine headaches, neck stiffness, dizziness, ringing in the ears, swallowing difficulties, and other disabling symptoms. But our overall assessment also includes our look into these people’s gastrointestinal symptoms.
(0:40) What are we looking for by way of gastrointestinal symptoms?
- We are looking for symptoms of:
- Very sensitive stomach
- Crohn’s disease
- Ulcerative Colitis
- Irritable Bowel Syndrome
Some of these people have a long history of gastrointestinal symptoms and cervical spine instability, yet the connection was never made for them. Yet a connection can be obvious.
In the illustration below, the many things the vagus nerve is responsible for are outlined. Highlighting digestive disorders, we see that the vagus nerve:
- Controls throat muscles to assist in swallowing
- Regulates insulin secretion and glucose balance (homeostasis) in the liver
- Regulates and controls digestion. Provides your brain with the feeling of satiation or “I’m full.” Helps regulate gastric juices, gut motility (the ability to move food through the digestive tract), and the production and regulation of stomach acids.
The vagus nerve, and its important role in digestion that we explained above, runs right in front of the C1 vertebra.
(0:55) The numbers of disrupted nerve cells and how they cause digestive impairment
- The vagus nerve cell bodies, that form the connection to the peripheral nerve processes of the visceral sensory nerves of the vagus, and their important role in digestion that we explained above, run right in front of the C1 vertebra. There are about 100,000 neurons in the vagus nerve and those 100,000 neurons have to tell the 100 million neurons in the enteric nervous system (the digestive system) what to do. So you can imagine if somebody has C1-C2 instability and the vagus nerve input to the digestive tract is hampered, there’s going to be a lot of enteric neurons in the digestive tract not working correctly.
(1:30) Digestive disorders and stomach acids
- When the vagus nerve is working correctly it tells the stomach to secrete stomach acid. But if you have a vagus nerve problem, stomach acid production may be impeded and you cannot break down your food properly.
- This would cause gastroesophageal reflux because the undigested food sits in your stomach and cause bloating
- The vagus nerve also stimulates the pancreas to make enzymes so think of the double whammy you can’t make stomach acid then your pancreas can’t make enzymes that digest the food. Then the food is not getting absorbed so, of course, you could get cramping and diarrhea.
- You may also suffer from fatigue and feel very tired because you’re not absorbing the nutrients from the food.
(2:25) Intestinal problems, constipation
- The vagus nerve also tells the intestines to contract so then if the vagus nerve isn’t working right you could also get constipation. In some cervical spine patients, they are taking laxatives to have a bowel movement. For some people, terrible constipation that they are suffering from has an undiscovered connection to their upper cervical or cervical instability issues.
(3:00) The liver and the spleen, fat absorption, and floating stools.
- Even secretions from the liver and the spleen which controls inflammation in the body that all depend on proper vagus nerve input so for people who have gallstones or their liver isn’t working right, what tells the liver to make bile? What tells the gallbladder to release the bile? It is the vagus nerve. So bile is necessary for fat absorption. If you have a vagus nerve issue from cervical instability you could have fat malabsorption. You would know you have fat malabsorption because your stools float. Stools are supposed to be the consistency of a banana, they’re supposed to slowly sink.
(4:05) Inflammation and spleen dysfunction
- The spleen controls information, if you have body-wide, chronic inflammation, maybe an autoimmune disease such as rheumatoid arthritis, lupus, Sjogren’s syndrome (dry eyes, dry mouth), there may be a cervical spine instability connection and there may be a structural cause of the disease which is cervical instability.
(4:30) Leaky gut syndrome
- The leaky gut syndrome can be the result of diminished or impeded vagus nerve signaling. The tight junctions of the digestive track widen and then substances get into the bloodstream that shouldn’t be there. If you have been treated for a long time with the leaky gut syndrome and you have vast food sensitivities and you’re not getting better you may actually have a structural cause of that condition called upper cervical instability hampering the vagus nerve flow and causing the condition.
We saw a patient who had seen a neurologist for migraines; an ear, nose, and throat doctor for dizziness, that they thought was a problem with her eustachian tubes. Then she had various barium swallow studies because she had swallowing difficulties. The worst symptom was that every time this patient ate she got bloated and suffered from all kinds of digestive problems. This led to hepatobiliary iminodiacetic acid (HIDA) scans of their gallbladder; liver CT scans; they had gastroenterology assessments with a tube stuck down their stomach and everything comes back normal.
Ross Hauser, MD, with patient Colonel Cope. The patient is a Colonel in the armed forces. A 21 year veteran.
A summary explanation of this video is found below.
Our patient was suffering from residual head pressure and a “whooshing noise” in her ears. These symptoms had developed twelve years prior when she was diagnosed with a cervical spinal fluid leak. Other symptoms include dizziness and feeling faint. She was able to manage these symptoms for a number of years, however, in more recent years her symptoms became worse. On her first visit, testing revealed compression on the vagus nerve and jugular vein. She was started on cervical curvature correction and Prolotherapy treatment. The patient describes that after the first treatment she noticed changes in her stomach. Her stomach was growling in a good way and she felt her digestion changing.
The patient was first diagnosed with acute Crohn’s Disease in 2015 after a visit to an emergency room for severe abdominal pain. She was diagnosed as having an intestinal stricture. It created an abscess and she was hospitalized for six weeks. Her doctors could not figure out what was causing the stricture. She was ultimately sent to surgery where two feet of her intestines were removed. She was ultimately diagnosed with Crohn’s Disease and it was after surgery that her symptoms began.
The time of this video, the patient was in for her fourth visit. Usually on the fourth visit we may re-test and reevaluate the progress the patient is taking.
So how do we treat a patient like this and how do we determine if these problems are from a vagus nerve compression in the neck?
1:25 of the video: So many of these ailments can be coming from a structural defect in the neck. For example, someone very close to me in my family has a lot of clearing of the throat and they’re always clearing their throat especially after eating. I always thought they needed a barium swallow study and the tests we just spoke about to see why swallowing was such a problem. Maybe I thought there was a narrowing of the esophagus but the doctors involved thought everything was okay and they recommended palliative (addressing only the symptoms) treatment. But I always thought there must be more going on and that needs to be treated with more than symptom suppression.
Assessing the cervical curve and how this may impact vagus nerve function and problems of swallowing and digestion.
We perform imaging to assess for the integrity of the cervical curve so as you can see here when the curve is normal we have a normal backward curved or lordosis, your head is sitting on top of your shoulders. In this position, the vagus nerve is properly positioned.
- When there is cervical spine instability, and there is a change to the natural curve of the neck, the vagus nerve is stretched and this stretching creates an unnatural tension on the nerve and this tension disrupts normal nerve signaling.
We see patients who are losing weight to the point that they should not lose anymore. When we put them in a cervical collar following Prolotherapy injections and we see them four days later they are eating again because “their stomach is working again.”
- A conduction block – when certain nerve impulses in the vagus nerve aren’t going through or not going through from the brain to the stomach or the stomach to the brain.
The vagus nerve isn’t supplying your stomach and your stomach’s not working and you’re severely constipated or your colon is not working and your doctor said he got all these food sensitivities that won’t go away while you might have it where the vagus nerve because the impulses to the enteric nervous system aren’t there to get leaky gut that is causing your autoimmune diseases.
Treating cervical ligaments with Prolotherapy – published research from Caring Medical
Prolotherapy is an injection technique that stimulates the repair of unstable, torn or damaged ligaments. When the cervical ligaments are unstable, they allow for excessive movement of the vertebrae, which can stress tendons, atrophy muscles, pinch on nerves, such as the vagus nerve, and cause other symptoms associated with cervical instability including problems of digestion among others.
In 2014, we published a comprehensive review of the problems related to weakened damaged cervical neck ligaments in The Open Orthopaedics Journal. (7) We are honored that this research has been used in at least 6 other medical research papers by different authors exploring our treatments and findings and cited, according to Google Scholar, in more than 40 articles.
In our clinical and research observations, we have documented that Prolotherapy can offer answers for sufferers of cervical instability, as it treats the problem at its source. Prolotherapy to the various structures of the neck eliminates the instability and the sympathetic symptoms without many of the short-term and long-term risks of cervical fusion. We concluded that in many cases of chronic neck pain, the cause may be underlying joint instability and capsular ligament laxity. Furthermore, we contend that the use of Comprehensive Prolotherapy appears to be an effective treatment for chronic neck pain and cervical instability, especially when due to ligament laxity. The technique is safe and relatively non-invasive as well as efficacious in relieving chronic neck pain and its associated symptoms.
In this video, DMX displays Prolotherapy before and after treatments
- In this video, we are using a Digital Motion X-Ray (DMX) to illustrate a complete resolution of a pinched nerve in the neck and accompanying symptoms of cervical radiculopathy.
- A before digital motion x-ray at 0:11
- At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
- At 0:34 DXM three months later after this patient had received two Prolotherapy treatments
- At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure on the nerve
- At 1:00 another DMX two months later and after this patient had received four Prolotherapy treatments
- At 1:14 the previously completely closed neural foramina are now opening normally during motion
Further reading: Cervical Spine Realignment and restoring loss of cervical lordosis
In our article Cervical Spine Realignment and restoring loss of cervical lordosis, Dr. Hauser presents the case that cervical spine, upper cervical spine, and lower cervical spine instability may be an unexplored cause of your neurologic-like, vascular-like and psychiatric-like conditions, and symptoms. It is very likely that you are reading this article as a continuation of your research into your symptoms and conditions and you came here from other pages on this website or that you landed here because a doctor, in many cases a chiropractor, mentioned to you that you have C1-C2 instability or C3-C7 instability. That this cervical instability has caused you to lose the natural curve or LORDOSIS in your neck. Further, you have started to come to terms with the understanding that all the tests that you have had performed by neurologists and cardiologists and the prescriptions offered to you by psychiatrists have never offered a “grand unifying theory” or help in diagnosing what was really wrong with you.
Further reading: Symptoms and conditions of Craniocervical Instability
In this article, Symptoms, and conditions of Craniocervical Instability, Dr. Hauser has put together a summary of some of the symptoms and conditions that we have seen in our patients either previously diagnosed or recently diagnosed with Craniocervical Instability, upper cervical spine instability, cervical spine instability, or simply problems related to neck pain.
For many of these people, symptoms, and conditions extended far beyond the neck pain, radiating pain of cervical radiculopathy, headaches, TMJ, and possibly dizziness usually associated with problems in the neck. These people’s symptoms and conditions extend into neurologic-type problems that may include digestion, irregular cardiovascular problems, hallucinogenic sensations, vision problems, hearing problems, swallowing problems, excessive sweating, and a myriad of others.
I want to point out that the symptoms and conditions you will see described below can be caused by many problems. This article demonstrates that craniocervical instability and cervical neck instability can be one of them.
Summary and contact us. Can we help you? How do I know if I’m a good candidate?
We hope you found this article informative and it helped answer many of the questions you may have surrounding Craniocervical Instability, upper cervical spine instability, cervical spine instability, or simply problems related to neck pain. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.
1 Song XH, Xu XX, Ding LW, Cao L, Sadel A, Wen H. A preliminary study of neck-stomach syndrome. World Journal of Gastroenterology: WJG. 2007 May 14;13(18):2575. [Google Scholar]
2 Traub RJ, Cao DY, Karpowicz J, Pandya S, Ji Y, Dorsey SG, Dessem D. A clinically relevant animal model of temporomandibular disorder and irritable bowel syndrome comorbidity. The Journal of Pain. 2014 Sep 1;15(9):956-66. [Google Scholar]
3 Breit S, Kupferberg A, Rogler G, Hasler G. Vagus nerve as modulator of the brain–gut axis in psychiatric and inflammatory disorders. Frontiers in psychiatry. 2018 Mar 13;9:44. [Google Scholar]
4 Bonaz B, Bazin T, Pellissier S. The vagus nerve at the interface of the microbiota-gut-brain axis. Frontiers in neuroscience. 2018 Feb 7;12:49. [Google Scholar]
5 Li H, Buisman‐Pijlman FT, Nunez‐Salces M, Christie S, Frisby CL, Inserra A, Hatzinikolas G, Lewis MD, Kritas S, Wong ML, Page AJ. Chronic stress induces hypersensitivity of murine gastric vagal afferents. Neurogastroenterology & Motility. 2019 Dec;31(12):e13669. [Google Scholar]
6 Klarer M, Arnold M, Günther L, Winter C, Langhans W, Meyer U. Gut vagal afferents differentially modulate innate anxiety and learned fear. Journal of Neuroscience. 2014 May 21;34(21):7067-76. [Google Scholar]
7 Steilen D, Hauser R, Woldin B, Sawyer S. Chronic neck pain: making the connection between capsular ligament laxity and cervical instability. The open orthopaedics journal. 2014;8:326. [Google Scholar]
8 Nouri A, Badhiwala JH, Kato S, Reihani-Kermani H, Patel K, Wilson JR, Janssen I, Cheng JS, Schaller K, Tessitore E, Fehlings MG. The relationship between gastrointestinal comorbidities, clinical presentation and surgical outcome in patients with DCM: analysis of a global cohort. Journal of clinical medicine. 2020 Mar;9(3):624. [Google Scholar]
9 Browning KN. Stress‐induced modulation of vagal afferents. Neurogastroenterology & Motility. 2019 Dec;31(12):e13758. [Google Scholar]
10 Gautron L. The phantom satiation hypothesis of bariatric surgery. Frontiers in Neuroscience. 2021 Feb 1;15:22. [Google Scholar]
11 Özçağlayan Ö, Özçağlayan Tİ, Doğru M, Mete R. Vagus nerve assessment via ultrasonography in irritable bowel syndrome. Are there any changes of dimension in the vagus nerve?. The Turkish Journal of Gastroenterology. 2020 Jul;31(7):503. [Google Scholar]
12 Bonaz B, Sinniger V, Pellissier S. Therapeutic potential of vagus nerve stimulation for inflammatory bowel diseases. Frontiers in neuroscience. 2021 Mar 22;15:300. [Google Scholar]
13 Eberhardson M, Levine YA, Tarnawski L, Olofsson PS. The brain–gut axis, inflammatory bowel disease and bioelectronic medicine. International Immunology. 2021 Jun;33(6):349-56. [Google Scholar]
14 Bisgaard TH, Allin KH, Keefer L, Ananthakrishnan AN, Jess T. Depression and anxiety in inflammatory bowel disease: epidemiology, mechanisms and treatment. Nature Reviews Gastroenterology & Hepatology. 2022 Jun 22:1-0. [Google Scholar]
15 Chuyue DY, Xu QJ, Chang RB. Vagal sensory neurons and gut-brain signaling. Current opinion in neurobiology. 2020 Jun 1;62:133-40. [Google Scholar]
16 Pellissier S, Dantzer C, Canini F, Mathieu N, Bonaz B. Psychological adjustment and autonomic disturbances in inflammatory bowel diseases and irritable bowel syndrome. Psychoneuroendocrinology. 2010 Jun 1;35(5):653-62. [Google Scholar]
17 Ratcliffe EM, Farrar NR, Fox EA. Development of the vagal innervation of the gut: steering the wandering nerve. Neurogastroenterology & Motility. 2011 Oct;23(10):898-911. [Google Scholar]
18 Gribble FM, Reimann F. Function and mechanisms of enteroendocrine cells and gut hormones in metabolism. Nature Reviews Endocrinology. 2019 Apr;15(4):226-37. [Google Scholar]
This article was updated November 25, 2022