GI Symptoms Could Be an Early Feature of MS, Study Finds

Patients with multiple sclerosis (MS) endure higher rates of drug dispensations and gastrointestinal (GI)-related events prior to disease onset, leading researchers to believe GI symptoms could constitute part of the MS prodrome, according to a recent study published in Annals of Clinal and Translational Neurology.

GI Symptoms Concept | image credit: ipopba - stock.adobe.com

MS researchers have increasingly turned their attention to the possibility of an MS prodrome. While the prodrome can manifest in a myriad of nonspecific symptoms, the authors of the present study point to research that has increasingly theorized about the role of one’s gut microbiome in the development of MS. Investigating these associations and whether GI symptoms are characteristic of the MS prodrome could provide valuable insights into disease’s pathology, as well as reshape how clinicians approach diagnoses and treatment.

Very few studies exist that evaluate the relationship between GI symptoms and MS. To address this gap, researchers analyzed the rates of GI conditions for patients with MS in the 5 years preceding their MS onset. Patients with MS were matched with up to 5 control individuals and their rates of GI-related physician visits and risks of GI-related dispensations were compared. Two cohorts were created in this study: an administrative cohort and a smaller clinical cohort.

In the administrative cohort, a total of 6863 patients with MS were identified between 1996 and 2013 throughout British Columbia and Canada. These patients were matched with 31,865 controls. Prior to an initial demyelinating event, data revealed that gastritis and duodenitis were the most prevalent GI-related conditions that spurned a physician visit (52.3 visits per 1000 person-years). Esophagus conditions were also among the most common (23.3 visits per 1000 person-years). Researchers noted that the frequency of physician visits prompted by these conditions were over 40% higher in the MS cohort compared to controls. Further analysis also considered the rates of prescription dispensation between the two groups. In those with MS, the highest risk for dispensation was observed for drugs used in the treatment of gastroesophageal reflux disease (GORD) and peptic ulcers (46 vs 33.9 prescriptions per 1000 person-years, 35% higher rate in MS cases than controls).

The clinical cohort consisted of 966 individuals with MS matched with 4534 controls. Similar to the administrative cohort, gastritis and duodenitis were the most prevalent GI-related events contributing to a physician visit (26.1 visits per 1000 person-years. Additionally, drug used in the treatment of GORD and peptic ulcers were the most frequently dispensed medications in those with MS (124.7 prescription fills per 1000 person-years).

In both cohorts, patients with MS also exhibited higher physician visitation rates related to “other” diseases of the intestines and peritoneum—such as irritable bowel syndrome and constipation—but these differences did not reach statistical significance.

In their concluding thoughts, investigators highlighted additional implications of GI issues in other diseases, and how these associations inform their findings. “Gut-related issues are known to pre-date other neurological conditions, particularly Parkinson’s disease (PD). Constipation can occur 5–10 years before classical motor onset PD and is well-recognized as a prodromal feature of PD. Combined with other observations, this has led to the suggestion of a gut origin and involvement of the gut microbiota for at least some portion of persons with PD,” Yusuf and colleagues stated, “Although our study did not directly examine the role of the gut microbiota in MS pathophysiology during the prodromal period, dysregulation of the gut–brain axis is one potential hypothesis for our findings.” While further studies are necessary to bolster these interrelationships occurring in the MS prodrome, the results of the investigators analyses suggest GI symptoms could be a precursor to the development of MS.

Reference

Yusuf FLA, Zhu F, Evans C, et al. Gastrointestinal conditions in multiple sclerosis prodrome. Ann Clin Transl Neurol. 2023 Dec 19. doi: 10.1002/acn3.51945