The VIBRANT-IBD study is a pilot, prospective, single-arm feasibility study investigating the effects of non-invasive vagus nerve stimulation (nVNS) in adults with inflammatory bowel disease (IBD) in clinical remission. Approximately 15 participants with Crohn's disease or ulcerative colitis will use the Nurosym auricular vagus nerve stimulation device daily for 28 days. Participants will undergo two magnetic resonance imaging (MRI) sessions, one before and one after the intervention. The MRI protocol will include structural imaging, diffusion-weighted imaging, MR angiography, and resting-state functional MRI (rs-fMRI) to assess brain structure and functional connectivity. Before and after the intervention, participants will complete standardised psychological and study-specific questionnaires assessing stress, anxiety, depression, fatigue, emotional functioning, body awareness (interoception), quality of life, gastrointestinal symptom-related experiences, and perceived effects of the intervention. Optional qualitative interviews will additionally explore participants' experiences of living with IBD and using vagus nerve stimulation. The study aims to evaluate the feasibility and preliminary neuropsychological and neurofunctional effects of non-invasive vagus nerve stimulation in individuals with IBD.
The VIBRANT-IBD study is a pilot, prospective, single-arm feasibility study designed to investigate the neuropsychological and neurofunctional effects of non-invasive vagus nerve stimulation (nVNS) in adults with inflammatory bowel disease (IBD) who are in clinical remission. The study focuses on individuals diagnosed with Crohn's disease or ulcerative colitis and aims to explore the relationship between vagal neuromodulation, brain functional connectivity, emotional functioning, stress regulation, fatigue, and quality of life. Approximately 15 adult participants will be recruited from a gastroenterology outpatient clinic and hospital department. Participants will undergo a 28-day intervention using the Nurosym device, a non-invasive auricular vagus nerve stimulation system. The stimulation will be self-administered daily following standardised instructions after participant training. The intervention involves stimulation of the auricular branch of the vagus nerve at the tragus area of the ear using mild electrical impulses. Stimulation will deliver at a frequency of 25 Hz with a pulse width of 250 µs. Stimulation intensity will be individually adjusted to a comfortable, clearly perceptible, non-painful level following standardized participant training. The total stimulation time will be 1.5 hours per day. The study aims to evaluate preliminary effects of this intervention, the feasibility, and acceptability in individuals with IBD in remission. Each participant will complete two magnetic resonance imaging sessions: one before the intervention and one after the 28-day stimulation period. MRI examinations will be performed using a 3T Magnetom Vida scanner equipped with a 64-channel head coil. The imaging protocol will include structural and functional neuroimaging assessments. Structural MRI will include standard anatomical imaging, high-resolution three-dimensional T1-weighted magnetisation-prepared rapid acquisition gradient echo (3D MPRAGE), diffusion-weighted imaging (DWI), and non-contrast MR angiography using the time-of-flight (TOF) technique. Functional magnetic resonance imaging (rs-fMRI) will be performed during resting-state conditions using T2-weighted Gradient Echo Echo-Planar Imaging (EPI) sequences to assess functional brain connectivity and neural networks. Participants will also complete a set of standardised psychological questionnaires before and after the intervention. These measures will assess anxiety (DASS-21), depression (DASS-21), stress (DASS-21), fatigue (IBD-F), resilience (RS14), interoceptive awareness (Brief MAIA-2), and quality of life (WHOQoL BREF). In addition, study-specific questionnaires developed for the project will evaluate, e.g., disease-related concerns, fear of relapse, stress-related gastrointestinal symptoms, and daily functioning. Post-intervention assessments will additionally examine treatment adherence, usability, and acceptability of the stimulation device, perceived therapeutic effects, and potential side effects. Optional qualitative interviews will also be conducted with interested participants to explore personal experiences related to living with IBD and using vagus nerve stimulation therapy. The primary objective of the study is to explore changes in brain functional connectivity following non-invasive vagus nerve stimulation in adults with IBD in remission. Secondary objectives are to evaluate the feasibility and safety of the intervention and to assess psychological outcomes, including associations between neuroimaging findings and psychological measures. The study may contribute to a better understanding of brain-gut interactions and the potential role of neuromodulation as a supportive non-pharmacological intervention in IBD.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
15
Participants will undergo non-invasive auricular vagus nerve stimulation (nVNS), also referred to as auricular vagal neuromodulation therapy (AVNT). The intervention is neuromodulatory and autonomic in nature and involves transcutaneous electrical stimulation of the auricular branch of the vagus nerve at the tragus region of the ear. The stimulation will be self-administered by participants at home after standardised training provided by the research team. The intervention period will last 28 consecutive days prior to the second MRI assessment. Participants will perform daily stimulation with a total target duration of 1.5 hours per day. A consistent 45-minute morning session will be required. Another session may be applied reactively during the day or in the evening hours. The total daily stimulation time should remain constant at 1.5 hours. Daily stimulation use, including session timing, duration, and adherence, will be recorded in a participant diary or device log.
Gastroenterology Department / Independent Public Healthcare Centre of the Ministry of Interior and Administration in Gdansk
Gdansk, Pomeranian Voivodeship, Poland
Change in resting-state functional brain connectivity following non-invasive vagus nerve stimulation
Resting-state functional magnetic resonance imaging will be used to assess changes in functional connectivity between baseline (pre-intervention) and post-intervention measurements following 28 days of daily auricular non-invasive vagus nerve stimulation using the Nurosym device. Analyses will focus on brain networks associated with emotional regulation, interoception, autonomic regulation, and stress processing.
Time frame: Baseline and at least 28 days post-intervention
Change in structural brain imaging measures following non-invasive vagus nerve stimulation
Structural magnetic resonance imaging (MRI) assessments, including high-resolution 3D T1-weighted imaging (MPRAGE), diffusion-weighted imaging (DWI), and MR angiography, will be used to explore potential changes in brain morphology, microstructural integrity, and vascular characteristics between baseline and post-intervention measurements.
Time frame: Baseline and at least 28 days post-intervention
Change in anxiety, depression, and stress levels
Changes in psychological distress will be assessed using the Depression Anxiety Stress Scales-21 (DASS-21). The DASS-21 is a 21-item self-report questionnaire measuring symptoms of depression, anxiety, and stress over the past week. It includes three 7-item subscales. Each item is rated from 0 to 3, and subscale scores are summed for each subscale, yielding raw subscale scores ranging from 0 to 21. Scores may also be multiplied by 2 to obtain scores comparable with the full 42-item DASS, resulting in subscale scores ranging from 0 to 42. Higher Depression, Anxiety, or Stress scores indicate greater symptom severity in the respective domain.
Time frame: Baseline and at least 28 days post-intervention
Change in fatigue severity
Fatigue-related symptoms and their impact on functioning will be assessed using the Inflammatory Bowel Disease Fatigue Scale (IBD-F). The IBD-F Scale includes a section on fatigue severity, frequency, and duration, and a section on the impact of fatigue on daily functioning. Items are scored from 0 to 4, with higher scores indicating greater fatigue or a greater impact of fatigue on everyday life. The fatigue severity, frequency, and duration section has a maximum score of 20, while the impact of fatigue on daily functioning section has a maximum score of 120. Higher scores reflect more severe fatigue-related symptoms and greater functional impact.
Time frame: Baseline and at least 28 days post-intervention
Change in quality of life
Quality of life will be evaluated using the Polish version of the World Health Organization Quality of Life questionnaire, WHOQOL-BREF. The WHOQOL-BREF is a short, generic self-report questionnaire. The tool contains 26 items: 24 items grouped into four domains - physical health, psychological health, social relationships, and environment - plus two general items assessing overall quality of life and satisfaction with health. Items are rated from 1 to 5, with higher scores generally indicating better quality of life. Raw domain scores are calculated by summing the items within each domain: physical health has a maximum raw score of 35, psychological health has a maximum raw score of 30, social relationships has a maximum raw score of 15, and environment has a maximum raw score of 40. The two general items are scored separately, each with a maximum score of 5. Domain scores may also be transformed to a 4-20 or 0-100 scale, with higher scores indicating better quality of life.
Time frame: Baseline and at least 28 days post-intervention
Change in interoceptive awareness
The Brief Multidimensional Assessment of Interoceptive Awareness, version 2 (Brief MAIA-2), is a 24-item self-report questionnaire used to assess interoceptive awareness, meaning how a person perceives, attends to, interprets, and trusts internal bodily sensations. The tool includes eight 3-item subscales: Noticing, Not Distracting, Not Worrying, Attention Regulation, Emotional Awareness, Self-Regulation, Body Listening, and Trusting. Items are rated from 0 (never) to 5 (always). Subscale scores are typically calculated as the mean of the three items in each subscale and therefore range from 0 to 5. If item scores are summed within each subscale, each 3-item subscale has a maximum score of 15, and the total maximum score across all 24 items is 120. Higher scores indicate greater interoceptive awareness or a stronger ability to perceive and use bodily sensations.
Time frame: Baseline and at least 28 days post-intervention
Change in psychological resilience
Psychological resilience will be measured using the Resilience Scale (RS-14). The scale consists of 14 items, each rated on a 7-point scale from 1 (strongly disagree) to 7 (strongly agree). Total scores range from 14 to 98, with higher scores indicating higher resilience.
Time frame: Baseline and at least 28 days post-intervention
Change in emotional functioning and stress-related gastrointestinal experiences
The self-constructed study-specific questionnaire will assess fear of disease relapse, emotional tension, stress-related gastrointestinal symptoms, body awareness, perceived control over health, psychosocial functioning, and expectations toward non-invasive vagus nerve stimulation. It will also assess participants' general health status on a 1-10 scale, where 1 indicates very poor health and 10 indicates very good health. Items are mainly rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating stronger agreement with each statement. As a study-specific tool, it should be treated as an exploratory questionnaire rather than a standardised validated scale.
Time frame: Baseline and at least 28 days post-intervention
Intervention adherence and usability
Participant adherence, usability, comfort, and acceptability of the intervention will be assessed using a study-specific post-intervention questionnaire. The questionnaire includes items on the frequency of stimulation, ease of device use, technical difficulties, perceived comfort, safety, willingness to continue therapy, and whether the participant would recommend it to others with IBD. It will also assess participants' general health status on a 1-10 scale, where 1 indicates very poor health and 10 indicates very good health. Most items are rated on a 5-point scale, with higher scores indicating more positive evaluation of the intervention. The questionnaire also records perceived changes in well-being, IBD-related functioning, stress response, adverse effects, and open-ended feedback about the therapy experience. As a study-specific tool, it should be treated as an exploratory questionnaire rather than a standardised validated scale.
Time frame: At least 28 days post-intervention
Occurrence of adverse events
Occurrence of adverse events will be measured using the study-specific post-intervention questionnaire. Participants will be asked whether any adverse events occurred during therapy, with multiple-choice response options including: no adverse events, discomfort at the stimulation site, headache, dizziness, fatigue, sleepiness, worsening of gastrointestinal symptoms, anxiety, and other symptoms specified by the participant. Additional comments can be provided in an open-text field. As a study-specific tool, it should be treated as an exploratory questionnaire rather than a standardised validated scale.
Time frame: At least 28 days post-intervention
Qualitative assessment of participant experiences
Optional semi-structured qualitative interviews will explore participant experiences related to living with IBD and using vagus nerve stimulation therapy. Interviews will be conducted up to one week after completion of the intervention, depending on participant availability.
Time frame: Up to 1 week after Day 28 intervention completion
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