Cervical spine instability and digestive disorders: Indigestion and irritable bowel syndrome caused by cervical spondylosis

Ross Hauser, MD

Functional dyspepsia (indigestion) and irritable bowel syndrome caused by cervical spondylosis

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 low back. I have developed chronic dizziness and lightheadedness, brain fog, balancing 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 lead 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 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 choke on 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 and lots of digestion issues and stomach pain.

To offer an explanation of one possible cause for functional dyspepsia (indigestion) and irritable bowel syndrome caused by cervical spondylosis

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 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.

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.

The image at (1:47 of the video presentation describing the offset of the C5 vertebrae to the C6).

This image shows the offset of the C5 vertebrae to the C6 and the subsequent formation of a bone spur

This image shows the offset of the C5 vertebrae to the C6 and the subsequent formation of a bone spur

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.

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

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 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.

stomach

An interesting study came out of Switzerland in 2018. (3) What makes this study interesting is that it was lead 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.

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.

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

In this study, mice were subjected to stress. The had exacerbated functional dyspepsia symptoms. Gastric vagal afferents mechanosensitivity, which may contribute to the 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.

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:

(0:40) What are we looking for by way of gastrointestinal symptoms?

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:

In this illustration, the many things the vagus nerve is responsible for is 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 felling of satiation or "I'm full." Helps regulate gastric juices, gut motility (the ability to move food through the digestive tract), and 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

(1:30) Digestive disorders and stomach acids

(2:25) Intestinal problems, constipation

(3:00) The liver and the spleen, fat absorption, and floating stools.

(4:05) Inflammation and spleen dysfunction

(4:30) Leaky gut syndrome

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 lead 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.

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?

Dr. Hutcheson and Dr. Hauser explain in the following video.

1:25 of the video: Dr. Hutcheson: 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.

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.”

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

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, that you have started to comes 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.

Please visit the Hauser Neck Center Patient Candidate Form

References

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]

This article was updated March 13, 2021

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