The Role of Repetitive Transcranial Magnetic Stimulation in Modulating Autonomic Dysfunction in Irritable Bowel Syndrome rTMS for IBS Autonomic Dysfunction

ABSTRACT Irritable bowel syndrome (IBS) is a chronic disorder of gut–brain interaction causing significant psychosocial burden. Increasing evidence suggests that autonomic nervous system dysfunction, maladaptive stress responsivity, and abnormal central pain processing play central roles in IBS pathophysiology. Altered sympathovagal balance, reduced parasympathetic tone, and dysregulated hypothalamic‐pituitary‐adrenal (HPA) axis activity have been consistently associated with symptom severity and quality of life. Repetitive transcranial magnetic stimulation (rTMS) is a noninvasive neuromodulatory intervention that modulates cortical excitability, autonomic regulation, emotional processing, and pain perception through targeted electromagnetic stimulation. Various brain areas and networks have shown altered activity and functional connectivity in IBS. Targeting these areas has been reported to be effective in the alleviation of IBS symptoms. Among these areas, stimulation of the dorsolateral prefrontal cortex (DLPFC) could modulate autonomic function. This review summarizes current evidence regarding autonomic abnormalities and stress dysregulation in IBS and evaluates the potential role of rTMS in modulating these mechanisms. Particular emphasis is placed on heart rate variability, visceral pain pathways, HPA‐axis dysfunction, emotional regulation, and cortical‐limbic‐autonomic interactions. Existing evidence suggests that rTMS may represent a promising neuromodulatory strategy for IBS; however, large‐scale studies remain necessary to establish optimal stimulation targets and protocols and long‐term efficacy.