Neurogenic bowel dysfunction in patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson’s disease

Abstract

Exciting new features have been described concerning neurogenic bowel dysfunction, including interactions between the central nervous system, the enteric nervous system, axonal injury, neuronal loss, neurotransmission of noxious and non-noxious stimuli, and the fields of gastroenterology and neurology. Patients with spinal cord injury, myelomeningocele, multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation, incontinence, gastrointestinal motor dysfunction and altered visceral sensitivity. Spinal cord injury is associated with severe autonomic dysfunction, and bowel dysfunction is a major physical and psychological burden for these patients. An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease. Multiple sclerosis is a neurodegenerative disorder in which axonal injury, neuronal loss, and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability. Parkinson's disease is a multisystem disorder involving dopaminergic, noradrenergic, serotoninergic and cholinergic systems, characterized by motor and non-motor symptoms. Parkinson's disease affects several neuronal structures outside the substantia nigra, among which is the enteric nervous system. Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease, even before the involvement of the central nervous system. This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease, as it could represent the point of entry for a putative environmental factor to initiate the pathological process. This review covers the data related to the etiology, epidemiology, clinical expression, pathophysiology, genetic aspects, gastrointestinal motor dysfunction, visceral sensitivity, management, prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases. Embryological, morphological and experimental studies on animal models and humans are also taken into account.

The prevalence of small intestinal bacterial overgrowth and methane production in patients with myelomeningocele and constipation

“…15 In our study, we confirm that children with MMC have a higher prevalence of SIBO compared with those observed in the control group of the literature. 16 Moreover, these children, as expected, showed a higher visual analog scale score of abdominal pain, bloating and flatulence compared with those without SIBO.…”

Gut microbiota, the immune system, and diet influence the neonatal gut–brain axis

“…A normal vs. an abnormal GBA involves multiple interactive cells and organs that create either health or disease (Figure 1). Pediatricians are familiar with morphologic defects in the (24). Congenital defects are not the only events that can occur in the fetus and affect development of the ENS.…”

Medication before and after a spinal cord lesion

“…However, the most conspicuous was the 6.31 times increase seen for ATC group A (alimentary tract and metabolism) reflecting the need of laxatives after the SCL. 7 Also, ATC group G (genitourinary system and sex hormones) was significantly increased reflecting the SCL impact on genito-urinary system. 13,14 The ATC group N (nervous system) also showed a highly significant increase after an SCL.…”

“…Still people with SCL are at high risk of developing disturbances related to the urinary tract, 5,6 and bowel, [7][8][9] together with several other physical and psychological challenges.…”