Neck-Stomach Syndrome: What is it?

Our bodies are immensely complicated from head to toe. We go about our daily lives without having to think about how our eyes adjust to different lighting, or how our digestive system allows us to taste, swallow, and digest food. We are fearfully and wonderfully made and the only time we really think about our bodies, is when something hurts or isn't working properly. Cervical instability can cause countless issues ranging from swallowing trouble to decreased contractility in the colon.

Pathophysiology

The Vagus nerve is at the root of many digestive issues when a person has cervical instability. Our brain communicates with our gut through the autonomic nervous system ( 2018, Bonaz, Bazin, & Pellisier). This microbiota ( communities of symbiotic organisms) - gut - brain communication is controlled by the vagus nerve through afferent pathways. It  navigates a complicated avenue and then sends the correct response (2018, Bonaz). It is believed that there is a cholinergic anti-inflammatory response that is controlled by the vagus nerve (2018, Bonaz). This allows the vagus nerve to decrease the peripheral inflammatory response and therefore change the permeability of the intestines (2018, Bonaz). As a result, the person can begin to suffer GI issues.

Stress, as we know, can cause many physical problems.  Stress also hinders the vagus nerve from working. As a result, IBS and IBD can be the result (2018, Bonaz). Stress enhances the permeability of the intestines and this changes the intestinal bacteria (2018, Bonaz). Changing the bacteria that naturally lives in the GI tract throws the balance off and therefore the person experiences reflux, diarrhea, etc. This can be characterized as a leaky gut (2018, Bonaz).

How Does This Happen?

The spine cradles a lot of nerves, and when they get impeded  by something such as a bone spur, then the patient can experience many complications (2021, Hauser). Cervical spondylosis is associated with TMJ and indigestion as well as the before mentioned IBS and IBD (2021, Hauser). The instability  usually lies in the C5 - C6 of the cervical spine (2021, Hauser). Other symptoms can include tinnitus, migraines, loss of balance, speech problems, and fainting (2021, Hauser).

Cervical stenosis allows for an unnatural hypermobility because of the frailty of the cervical ligament (2021, Hauser). Since the vagus nerve provides 75% of the input for the parasympathetic nervous system, it is responsible for regulating the sphincter muscles and intestinal movement (2021, Hauser). The GI tract has many sphincters that protect us from reflux of either bile, food, or stool. There is an upper and lower esophageal sphincter that opens and lets food into the esophagus, and then the stomach. These not only allow for food to go down, but prevents fluids and food from refluxing back up into the mouth or lungs.

Once the stomach breaks down food, the pylorus, the valve at the bottom of the stomach opens and allows the food into the duodenum. At the end of the small bowel and the beginning of the colon is the ileocecal valve. This valves allow the stool to move into the colon and eventually the anal sphincter allows us to have a bowel movement. So as you can see, the malfunctioning of these valves can cause many problems.

The vagus nerve also controls insulin regulation, and keeps the liver balanced regarding glucose (2021, Hauser). It tells our brain that we are full, regulates our gastric acid and other juices (2021, Hauser). If any of these things don't function properly, we get bloating, diarrhea, and fatigue  from our stomach not being able to break down foods (2021, Hauser). Without the proper amount of bile, our body cannot absorb fat. Also, since the vagus nerve controls motility, a person can get constipated, or have gastric stasis (2021, Hauser).

Treatment

There isn't a lot of literature specifically on the neck-stomach syndrome, and the symptoms can be over a broad spectrum. Treatment other than surgery include prebiotics and probiotics. Also mentioned in Bonaz's article is fecal microbiota transplantation (2018). Addressing the reason behind the stress through cognitive behavioral therapies is mentioned as well (2018, Bonaz). Hopefully more studies will be conducted so that treatment can be more specific and this malady will be better understood. (In the link below, the doctor talks about a specific treatment of prolotherapy)

Conclusion

When I asked one of the GI doctors about this neck-stomach syndrome, he had never heard of it. He has practiced for many years, and is a very good diagnostician. This leads me to think that this syndrome is often missed. It's amazing to think that the vagus nerve is so vital to our well-being. As we continue to learn, we can better help our patients. If you would like to watch some videos explaining this more, along with a lot of diagrams and good information, check out the links below,

References

Bonaz, B., Bazin, T., & Pellisier, S. (2018). The Vagus Nerve at the Interface of the Microbiota-Gut-Brain Axis. Frontiers in NeuroScience, 12(49).

Hauser, R. (2021). Cervical Spine Instability as a Cause of Your Digestive Disorders. Caring Medical Florida.