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age, severity of comorbid mental disorders (anxiety, depression), and the degree of autonomic nerve dysfunction will also affect the regulatory effect of VNS on the brain-gut axis ( 5 Study limitations The existing clinical trials are mostly single-center and small-sample studies, which have problems such as short follow-up periods, insufficient data on long-term efficacy and recurrence rates, and are centered around IBS-C patients

The switch from an immunologically centered pathogenetic hypothesis to a metabolic-based theory would represent a groundbreaking change in the setting of vitiligo for its therapeutic implications

Liguori et al

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A.D.A.M