Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: A 14‐year cohort study

Abstract

Background Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease frequently complicated by bowel symptoms. Multiple sclerosis typically first manifests with a demyelination event, also known as a clinically isolated syndrome (CIS). We sought to examine the prevalence of prodromal bowel symptoms predating a CIS in patients with MS as part of a recently characterized prodromal phase of disease. Methods We constructed a retrospective cohort of MS patients with bowel symptoms and an identifiable CIS at two tertiary care centers over 14 years using administrative and billing data. We determined the date of onset of reported bowel symptoms in comparison with the date of first CIS and determined the overall prevalence of prediagnosis bowel symptoms within 1, 2, 3, and >3 years from a CIS. We used multivariable modeling to determine demographic and clinical risk factors for prediagnosis bowel symptoms. Key Results Among 385 MS patients with reported bowel symptoms, 122 (31.6%) reported bowel symptoms prior to CIS. The most common first bowel symptom was constipation (50.0%), followed by diarrhea (29.5%). The average lead time between a first bowel symptom and a CIS event was 3.7 ± 3.4 years. Pre‐CIS fatigue (OR 4.48, 95% CI: 2.68‐7.51, P < 0.001) and pre‐CIS sensory disturbances (OR 1.88, 95% CI: 1.15‐3.08, P < 0.05) were all associated with bowel symptoms prior to a CIS event. Conclusions and Inferences Nearly a third of MS patients with bowel symptoms reported bowel symptoms prior to a demyelinating event/CIS. Characterization of a prodromal phase of disease may provide important insights into understanding disease progression.

Interactions between host genetics and gut microbiota determine susceptibility to CNS autoimmunity

“…While multiple human studies have shown alterations in the gut microbiome of MS patients, it is unclear whether these represent an MS high-risk microbiome, are simply a byproduct of the GI disturbances that are highly prevalent in MS (20,45), or are an effect of the immune modulation by MS disease-modifying therapy treatment (23). In contrast, the EAE model allows us to determine and modulate the microbiome state prior to disease onset.…”

Prevalence and predictors of bowel dysfunction in a large multiple sclerosis outpatient population: an Italian multicenter study

“…MS specialists should systematically and proactively screen/check for NBD symptoms in clinical practice, since these latter are too often considered a taboo topic by both patients and physicians, [ 1 ] such that the large majority of MS patients tend to do not refer these symptoms and passively accept them. The proactive screening should be extended also to young MS patients with low disability, taking into account that moderate to severe constipation has been reported also as an early symptom, or even a prodrome, of MS [ 2 , 3 ].…”

“…Neurogenic bowel dysfunction (NBD) is a common and disabling feature of multiple sclerosis (MS) and appears to be associated with the presence of bladder dysfunction, high level of disability, and long disease duration[ 1 ], even if it is described also in early phase of the disease [ 2 , 3 ].…”

Gastrointestinal motility disorders in neurologic disease

“…These result from impaired function of the supraspinal or descending pathways that control Onuf 's nucleus (sacral parasympathetic outflow). As in Parkinson disease, bowel symptoms predate the diagnosis among many patients with MS, based on a 14-year cohort study (96).…”