Irritable Bowel Syndrome In Multiple Sclerosis Patients and Its Relation To Attacks

Dicle Tıp Dergisi / Dicle Med J (2021) 48 (2) : 253-259 Original Article / Özgün Araştırma Irritable Bowel Syndrome In Multiple Sclerosis Patients and Its Relation To Attacks Gökçe Zeytin Demiral 1, Ülkü Türk Börü 4, Bahadır H Demiral 1, Cem Bölük 5, Mustafa Taşdemir 2, Emel Ahıshalı 3, Sanem Coşkun Duman 6 1 Afyonkarahisar University of Health Sciences, Department of Neurology, Afyon, Turkey 2 İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, İstanbul, Turkey 3 Koç University, Department of Gastroenterology, Istanbul, Turkey 4 Koç University, Department of Neurology, Istanbul, Turkey 5 Afyonkarahisar Public Health Center, Department of Family Medicine, Afyonkarahisar, Turkey 6 Istanbul Medeniyet University, Department of Public Health, Istanbul, Turkey Received: 07.02.2021; Revised: 13.04.2021; Accepted: 14.04.2021 Abstract Objective: Knowledge about bidirectional microbiome-gut-brain interactions has gradually increased in multiple sclerosis (MS) and many other diseases. The aim of this study is to determine the prevalence of irritable bowel syndrome (IBS) in MS patients, to compare with a control group and to identify the relationship between MS attacks and gastrointestinal (GI) symptoms. Methods: Patients with at least a two-year diagnosis of relapsing-remitting MS (RRMS) from our outpatient clinic were included in the study. The duration of disease, expanded disability status scale and time of MS attacks were recorded. ROME- IV criteria were used for diagnosis of IBS. Results were compared with the control group. IBS symptoms prior to, during and after an attack were recorded and their relationship to MS attacks was investigated. Results: 93 RRMS patients and 101 controls were included in this study. The prevalence rate of IBS was found to be 16.1% (n=15) in MS patients and 8.9% (n=9) in the control group. No significant difference can be found in IBS prevalence rate between MS patients and controls (p=0.127). MS attacks had no significant effect on constipation, diarrhea, abdominal pain and distention. Conclusion: This study showed that MS patients have a similar IBS prevalence to the control group. In addition, MS attacks have no significant effect on GI symptoms. Keywords: Abdominal Pain, Constipation, Diarrhea, Irritable Bowel Syndrome, Multiple Sclerosis DOI: 10.5798/dicletip.944374 Correspondence / Yazışma Adresi: Cem Bölük, Istanbul University Cerrahpaşa- Cerrahpaşa Faculty of Medicine, Department of Neurology, Fatih, Istanbul, Turkey e-mail: 253 Zeytin Demiral G., Türk Börü Ü., Bölük C., et al. Multipl Skleroz Hastalarında İrritabl Barsak Sendromu ve Ataklarla Olan İlişkisi Öz Amaç: Multipl skleroz (MS) ve diğer hastalıklarda; mikrobiyom-barsak ve beynin iki yönlü etkileşimi konusundaki bilgi birikimi giderek artmaktadır. Bu çalışmanın amacı MS hastalarında irritabl barsak sendromu prevalansını belirlemek, kontrol grubu ile karşılaştırmak ve MS atakları ile gastrointestinal semptomlar arasındaki ilişkiyi belirlemektir. Yöntemler: Kliniğimizce en az 2 yıldır yineleyici MS (RRMS) teşhisi ile izlenen hastalar çalışmaya dâhil edildi. Hastalık süresi, özürlülük skalası (EDSS) ve MS atak zamanları kaydedildi. Irritabl barsak sendromu tanısında Roma-IV kriterleri kullanıldı. Sonuçlar kontrol grubu ile karşılaştırıldı. MS atakları öncesindeki, atak sırasındaki ve sonrasındaki gastrointestinal semptomlar kaydedilerek MS atakları ile ilişkisi araştırıldı. Bulgular: 93 RRMS hastası ve 101 kontrol çalışmaya dâhil edildi. MS hastalarında irritabl barsak sendromu prevalansı %16,1 (n=15) bulunurken, kontrol grubunda %8,9 (n=9) bulundu. İrritabl barsak sendromu sıklığı açısından MS hastaları ve sağlıklı kontroller arasında istatistiksel olarak anlamlı farklılık izlenmedi (p=0,127). MS ataklarının ishal, kabızlık, şişkinlik ve karın ağrısı üzerine anlamlı etkisi bulunamadı. Sonuç: Bu çalışma MS hastalarındaki irritabl barsak sendromu sıklığının sağlıklı kontroller ile benzer olduğunu göstermiştir. Ayrıca MS ataklarının gastrointestinal semptomlar üzerine anlamlı etkisi yoktur. Anahtar kelimeler: İshal, kabızlık, karın ağrısı, irritabl barsak sendromu, multipl skleroz. INTRODUCTION Comorbidity has become a subject of increasing interest in multiple sclerosis (MS) due to the emergence of evidence that comorbidity is linked with diagnostic delay, the progression of disability, health-related quality of life and the progression of lesion burden on magnetic resonance imaging (MRI)1-5. With that said, the reported prevalence of comorbidity in MS varies greatly, this depends on the number and type of conditions considered along with the characteristics of the study population6,7. Neurologists in their examination of MS patients often focused on sensorial and motor symptoms. Over the last twenty years, gastrointestinal (GI) symptoms have been noticed and used in patient assessments. GI symptoms such as constipation, dysphasia and fecal incontinence are observed in the majority of MS patients. By means of these, connections between the intestine and the brain have been researched. Knowledge about bidirectional microbiome-gut-brain interactions has gradually increased in MS and many other diseases. It is indicated that a disordered brain may cause gastrointestinal symptoms by affecting motility, acid secretion and mucosal immune response through sympathetic and parasympathetic branches of its autonomic nervous system8-10. Studies on irritable bowel syndrome (IBS) in MS patients are limited and these studies were carried out alongside other comorbid conditions. The results of these studies recorded a changeable prevalence rate of IBS in MS patients11. The first aim of this study is to validate the results of previous studies by investigating and comparing the prevalence rates of IBS in MS patients and controls. The second aim is to bring gastrointestinal symptoms of MS patients to light by investigating the relationship between GI symptoms and MS attacks. METHODS The MS patients who participated in this study were recruited from the outpatient clinic of a university hospital. All participating patients were existing patients at our clinic and were already being followed by our clinic and our neurologists. 254 Dicle Tıp Dergisi / Dicle Med J (2021) 48 (2) : 253-259 minimum as 98 patients in each group with 95% two-sided significance level and 80% power if the percentage of IBS prevalence were 19.3% with MS and 6% with a control group. The assumptions regarding the estimated between-group difference were based on epidemiological studies11. The Rome- IV criteria were used to diagnose IBS12. A questionnaire was prepared by deriving Turkish validated form of the adult functional GI disorders Questionnaire13. The questionnaire includes 5 subgroups one of which is aimed at IBS. The IBS diagnostic criteria: Recurrent abdominal pain at least 1 day per week in the last 3 months (on average), asso (...truncated)