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.
- 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.
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.
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
- 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 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:
- We see many patients with clicking, grinding, crunching in their neck. 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 its important role in digestion that we explained above, runs 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 depends on proper vagus nerve input so 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 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 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.
- 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, 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.
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This article was updated March 13, 2021