Auricular Neurostimulation: A Novel Therapy for Abdominal Pain-Related Disorders of Gut-Brain Interaction

Disorders of gut-brain interaction (DGBI) are highly prevalent in the pediatric population. DGBI are heterogeneous disorders with presumed multifactorial pathophysiology. Emerging studies document autonomic nervous system alterations in at least a subset. There is significant symptom overlap among the most common DGBI categories and suboptimal clinical characterization. Extraintestinal comorbidities are frequent and contribute to a rising health care burden. Most therapies are either gut-directed or empirically aimed at desensitizing brain-gut signals. There are a lack of targeted, safe, and effective therapies. Percutaneous electrical nerve field stimulation (PENFS) is a nonpharmacologic neurostimulation device that targets vagal pathways via the external auricle. Four-week cycles of PENFS therapy have demonstrated efficacy for various abdominal pain–related DGBI in children. PENFS has a high safety profile with minimal side effects in large cohort studies. Although access remains challenging because of the need for device placements by certified clinicians along with limited reimbursement, auricular PENFS is a promising, noninvasive, and targeted therapy for pediatric DGBI with underlying autonomic dysregulation.