Gastrointestinal motility disorders in patients with multiple sclerosis: A single‐center study

Abstract

Background Most prevalent gastrointestinal symptoms in multiple sclerosis (MS) relate to lower bowel dysfunction, often in association with bladder manifestations. Objective To assess clinical and objective gastrointestinal motor dysfunctions in patients with MS. Methods This was a single‐center, retrospective study of 166 patients evaluated between 1996 and 2020. We reviewed characterization of the MS, gastrointestinal and neurological symptoms, measurements of gastrointestinal and colonic transit, and anorectal manometry. Key Results At the time of the gastrointestinal evaluations of the 166 patients with MS (138 women; 83%), 111 were in the relapsing‐remitting phase and 52 were in the progressive phase. In 3 patients, disease phase was not assigned due to insufficient data. Constipation was identified in 82% (136/166) of patients. Most [103/116 (88%)] patients with bladder symptoms also had constipation or fecal incontinence. Delayed gastric emptying at 4 h and colonic transit at 24 h was identified in 16% and 7% of the cohort, respectively; 22% had accelerated gastric emptying. On anorectal manometry, resting anal sphincter pressure >90 mm Hg and rectoanal pressure differential below −50mm Hg suggested evacuation disorder in patients with constipation. Conclusions and Inferences In addition to slow colonic transit and anorectal dysfunction leading to constipation in MS, 22% of patients had accelerated gastric emptying.

Gastrointestinal Dysfunction in Multiple Sclerosis and Related Conditions

“…41 In a more recent retrospective cohort study, Khanna and colleagues studied 166 patients with MS who also had undergone scintigraphic GI and colonic transit studies and anorectal manometry studies and noted the frequent presence of bowel dysfunction, with constipation in 82%, rectal evacuation disorder in 18%, and slowed colon transit in 7%. 42 They also documented changes in gastric emptying in their MS patients, with delayed gastric emptying in 16% and accelerated emptying in 22%. 42 Other studies have reported the occurrence of fecal incontinence in 31 to 50% of MS patients.…”

“…42 They also documented changes in gastric emptying in their MS patients, with delayed gastric emptying in 16% and accelerated emptying in 22%. 42 Other studies have reported the occurrence of fecal incontinence in 31 to 50% of MS patients. [43][44][45] COMPASS-31 (composite autonomic symptom score-31), a tool for detecting autonomic symptoms, also has been used to assess constipation in patients with MS. 46 Although bowel dysfunction in MS is more likely to be evident in older individuals with more long-standing disease and higher spinal cord involvement on imaging, 42 in one study of MS patients experiencing bowel symptoms, the bowel symptoms were evident prior to the diagnosis of MS in nearly one-third of patients.…”

“…42 They also documented changes in gastric emptying in their MS patients, with delayed gastric emptying in 16% and accelerated emptying in 22%. 42 Other studies have reported the occurrence of fecal incontinence in 31 to 50% of MS patients. 43 44 45 COMPASS-31 ( comp osite a utonomic s ymptom s core-31), a tool for detecting autonomic symptoms, also has been used to assess constipation in patients with MS. 46…”

“…Gastroparesis, indicated by prolonged gastric emptying, has been described most frequently, but as noted above, accelerated gastric emptying was even more frequently evident in one study. [58][59][60][61][62] Abdominal X-rays can visualize IPO/paralytic ileus. 38 Delayed CTT can also be identified by bowel function testing [63][64][65] even when rectal videomanometry confirms intact rectal sensory parameters.…”

“…Although bowel dysfunction in MS is more likely to be evident in older individuals with more long-standing disease and higher spinal cord involvement on imaging, 42 in one study of MS patients experiencing bowel symptoms, the bowel symptoms were evident prior to the diagnosis of MS in nearly one-third of patients. 44 Constipation may even be the presenting symptom of MS. 45 MS can affect much of the neuraxis, making it a challenge to ascertain which lesion site is responsible for the GI symptoms of a patient with MS. 44…”