Auricular Percutaneous Electrical Nerve Field Stimulation in Disorders of Gut–Brain Interaction: A Clinician’s Approach
DOI:
https://doi.org/10.69734/56j54089Keywords:
Percutaneous electrical nerve field stimulation (PENFS), auricular vagal nerve stimulation (aVNS), transcutaneous auricular vagus nerve stimulation (taVNS), IB-Stim, disorders of gut–brain interaction (DGBI), pediatric DGBI, irritable bowel syndrome (IBS), functional dyspepsia (FD), cyclic vomiting syndrome (CVS), functional nausea, functional abdominal pain–not otherwise specified (FAP-NOS), functional abdominal pain disorders (FAPD), postural orthostatic tachycardia syndrome (POTS), avoidant/restrictive food intake disorder (ARFID), visceral hypersensitivity, central sensitization, autonomic dysfunction, vagal withdrawal, gut–brain axis, nucleus tractus solitarius (NTS), neuromodulation, non-pharmacologic therapy, chronic abdominal pain, chronic nauseaAbstract
Chronic abdominal pain, chronic nausea and autonomic symptoms are common, debilitating complaints in children and young adults with disorders of gut–brain interaction (DGBI)1. Despite a broad range of pharmacologic and behavioral therapies, many patients experience incomplete relief or medication-related side effects, underscoring a major unmet need for safe, non-pharmacologic neuromodulatory treatments.1,2
Auricular percutaneous electrical nerve field stimulation (PENFS), delivered via a small wearable device placed behind the ear represents an emerging, minimally invasive neuromodulation strategy aimed at modulating central autonomic and visceral pain pathways.3 By stimulating afferent auricular branches of the cranial nerves supplying the gastrointestinal (GI) tract, predominantly the vagus nerve, this therapy seeks to rebalance dysregulated gut–brain signaling implicated in nausea, visceral hypersensitivity, and autonomic dysfunction.4
This article outlines the physiologic rationale for auricular PENFS, available devices, predicted effectiveness across relevant clinical conditions, and a practical approach to patient selection, treatment implementation, and monitoring in clinical practice.
References
Drossman DA, Hasler WL. Rome IV-functional GI disorders: Disorders of gut-brain interaction. Gastroenterology. 2016;150(6):1257-61.
Singh R, Zogg H, Ghoshal UC, et al. Current treatment options and therapeutic insights for gastrointestinal dysmotility and functional gastrointestinal disorders. Front Pharmacol. 2022;13:808195.
Kovacic K, Hainsworth K, Sood M, et al. Neurostimulation for abdominal pain-related functional gastrointestinal disorders in adolescents: A randomised, double-blind, sham-controlled trial. Lancet Gastroenterol Hepatol. 2017;2(10):727–37.
Chogle A, El-Chammas K, Santucci N, et al. A multicenter registry study on percutaneous electrical nerve field stimulation for pediatric disorders of gut–brain interaction. J Pediatr Gastroenterol Nutr. 2024;78:817–26.
Wang Y, Duan C, Du X, et al. Vagus nerve and gut-brain communication. Neuroscientist. 2025;32(3):262-78.
Couceiro S, Sant'Anna L, Sant'Anna M, et al. Auricular vagal neuromodulation and its application in patients with heart failure and reduced ejection fraction. Arq Bras Cardiol. 2023;120(5):e20220581.
Kovacic K, Di Lorenzo C. Functional nausea in children. J Pediatr Gastroenterol Nutr. 2016;62(3):365-71.
Krasaelap A, Sood MR, Li BUK, et al. Efficacy of auricular neurostimulation in adolescents with irritable bowel syndrome in a randomized, double-blind trial. Clin Gastroenterol Hepatol. 2020;18(9):1987-94.e2.
Neuraxis awarded first-ever FDA clearance for treatment of pediatric functional dyspepsia and related symptoms. Retrieved February 5, 2026, from https://ir.neuraxis.com/news-releases/news-release-details/neuraxis-awarded-first-ever-fda-clearance-treatment-pediatric.
Santucci NR, Beigarten AJ, Khalid F, et al. Percutaneous electrical nerve field stimulation in children and adolescents with functional dyspepsia-integrating a behavioral intervention. Neuromodulation. 2024;27(2):372-81.
Venkatesan T, Prieto T, Barboi A, et al. Autonomic nerve function in adults with cyclic vomiting syndrome: A prospective study. Neurogastroenterol Motil. 2010;22(12):1303-7, e339.
Bolender A, Staley R, Garcia RG, et al. Altered parasympathetic outflow and central sensitization response to continuous pain in cyclic vomiting syndrome: A functional magnetic resonance imaging study. Am J Physiol Gastrointest Liver Physiol. 2025;328(2):G125-35.
Karrento K, Rosen JM, Tarbell SE, et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition 2025 guidelines for management of cyclic vomiting syndrome in children. J Pediatr Gastroenterol Nutr. 2025;80(6):1028-61.
Nassif MA, El-Chammas K, Graham K, et al. A pilot study investigating improvement in functional nausea after percutaneous electrical nerve field stimulation (PENFS).
Castillo DF, Denson LA, Haslam DB, et al. The microbiome in adolescents with irritable bowel syndrome and changes with percutaneous electrical nerve field stimulation. Neurogastroenterol Motil. 2023;35(7):e14573.
Wang LB, Culbertson CJ, Deb A, et al. Gastrointestinal dysfunction in postural tachycardia syndrome. J Neurol Sci. 2015;359(1-2):193-6.
Stavrakis S, Chakraborty P, Farhat K, et al. Noninvasive vagus nerve stimulation in postural tachycardia syndrome: A randomized clinical trial. JACC Clin Electrophysiol. 2024;10(2):346-55.
Santucci NR, King C, El-Chammas KI, et al. Effect of percutaneous electrical nerve field stimulation on mechanosensitivity, sleep, and psychological comorbidities in adolescents with functional abdominal pain disorders. Neurogastroenterol Motil. 2022;34(8):e14358.
Karrento K, Zhang L, Conley W, et al. Percutaneous electrical nerve field stimulation improves comorbidities in children with cyclic vomiting syndrome. Front Pain Res (Lausanne). 2023;4:1203541.
Waheed U, VonAxelson A, El-Chammas K, et al. Percutaneous electrical nerve field stimulation improves weight and other anthropometric outcomes in children and adolescents with functional dyspepsia who restrict their oral intake. Neurogastroenterol Motil. In press.
Kolacz J, Roath OK, Lewis GF, et al. Cardiac vagal efficiency is enhanced by percutaneous auricular neurostimulation in adolescents with nausea: Moderation by antidepressant drug exposure. Neurogastroenterol Motil.2025;37(5):e15007.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 SMART-MD Journal of Precision Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Journal information