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Cited by 51Multiple Sclerosis Research StudiesUrinary Bladder and Prostate ResearchGastrointestinal motility and disorders

Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease

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Preziosi, Giuseppe, Raptis, Dimitri A., Raeburn, Amanda, Thiruppathy, Kumaran, Panicker, Jalesh, Emmanuel, Anton·2013·European Journal of Gastroenterology & Hepatology
DOI 10.1097/meg.0b013e328361eaf8PMC PMC4206376
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Abstract

OBJECTIVES: Bowel and bladder symptoms are highly prevalent in patients with multiple sclerosis (MS). Bladder dysfunction (affecting 75% of these patients) is caused by disease in the spinal cord, whilst the pathophysiology of bowel dysfunction is unknown. Pathways regulating both the organs lie in close proximity to the spinal cord, and coexistence of their dysfunction might be the result of a common pathophysiology. If so, the prevalence of bladder symptoms should be greater in patients with MS and bowel symptoms. This hypothesis is tested in the study. We also evaluated how patient-reported symptoms quantify bowel dysfunction. PATIENTS AND METHODS: The Neurogenic Bowel Dysfunction questionnaire and the presence of bladder symptoms were recorded in 71 patients with MS and bowel symptoms. Disability, a surrogate clinical measure of spinal cord disease, was assessed using the Expanded Disability Status Scale. Bowel and bladder symptoms were quantified by patient-reported frequency, expressed in time percentage (0, 25, 50, 75 or 100% of the time the symptom was perceived), and patient-reported severity on a visual analogue scale between 0 and 100. RESULTS: The prevalence of bladder symptoms was 85%, which is higher than that expected in an unselected population of patients with MS. Neurogenic Bowel Dysfunction score was significantly correlated with both patient-reported frequency (r=0.860, P<0.0001) and severity of bowel symptoms (r=0.659, P=<0.0001), as well as with the Expanded Disability Status Scale (r=0.526, P<0.0001). CONCLUSION: Our findings suggest that gut dysfunction in patients with MS is secondary to spinal cord disease. Patient-reported bowel symptoms quantify bowel dysfunction well.

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  • The visual analogue scale assessment tool has previously been applied and validated by Preziosi et al. to evaluate gastrointestinal symptoms in patients with multiple sclerosis.

    “This assessment tool has previously been applied and validated by Preziosi et al. to evaluate GI symptoms in patients with MS [23].”

    From The effects of ginger supplementation on common gastrointestinal symptoms in patients with relapsing-remitting multiple sclerosis: a double-blind randomized placebo-controlled trial (2023) · cites this paper as [23]

    In Symptoms assessments (page unavailable), Preziosi et al. used a 0–100 visual analogue scale to assess bowel-symptom severity in patients with MS. Results reports that patient-reported severity correlated with NBD scores, and Discussion says simple questioning was as accurate as a validated questionnaire. The paper does not say that the visual analogue scale itself was validated in patients with MS. (LLM, conf=0.88)

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Research works printed but not linked: 44

  1. [1]Nordenbo AM Andersen JR Andersen JT. Disturbances of ano-rectal function in multiple sclerosis. J Neurol 1996; 243: 445– 451 8803816
  2. [2]Hornby A. The MS sufferer in the community. Nurs Times 1978; 74 Suppl 130– 131 652561
  3. [3]Norton C Chelvanayagam S. Bowel problems and coping strategies in people with multiple sclerosis. Br J Nurs 2010; 19: 1– 6 20220671
  4. [4]Nortvedt MW Riise T Frugard J Mohn J Bakke A Skar AB. Prevalence of bladder, bowel and sexual problems among multiple sclerosis patients two to five years after diagnosis. Mult Scler 2007; 13: 106– 112 17294618
  5. [5]Swash M Snooks SJ Chalmers DH. Parity as a factor in incontinence in multiple sclerosis. Arch Neurol 1987; 44: 504– 508 3579661
  6. [6]Wiesel PH Norton C Glickman S Kamm MA. Pathophysiology and management of bowel dysfunction in multiple sclerosis. Eur J Gastroenterol Hepatol 2001; 13: 441– 448 11338078
  7. [7]DasGupta R Fowler CJ. Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies. Drugs 2003; 63: 153– 166 12515563
  8. [8]Betts CD D’Mellow MT Fowler CJ. Urinary symptoms and the neurological features of bladder dysfunction in multiple sclerosis. J Neurol Neurosurg Psychiatry 1993; 56: 245– 250 8459239 PMC1014855
  9. [9]Gilman S Low PA Quinn N Albanese A Ben-Shlomo Y Fowler CJ. Consensus statement on the diagnosis of multiple system atrophy. J Auton Nerv Syst 1998; 74: 189– 192 9915636
  10. [10]Hinds JP Eidelman BH Wald A. Prevalence of bowel dysfunction in multiple sclerosis. A population survey. Gastroenterology 1990; 98: 1538– 1542 2338192
  11. [11]Munteis E Andreu M Tellez MJ Mon D Ois A Roquer J. Anorectal dysfunction in multiple sclerosis. Mult Scler 2006; 12: 215– 218 16629426
  12. [12]Chia YW Fowler CJ Kamm MA Henry MM Lemieux MC Swash M. Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction. J Neurol 1995; 242: 105– 108 7707085
  13. [13]Craggs MD Balasubramaniam AV Chung EA Emmanuel AV. Aberrant reflexes and function of the pelvic organs following spinal cord injury in man. Auton Neurosci 2006; 126-127: 355– 370 16731049
  14. [14]Weber J Denis P Mihout B Muller JM Blanquart F Galmiche JP. Effect of brain-stem lesion on colonic and anorectal motility. Study of three patients. Dig Dis Sci 1985; 30: 419– 425 3987475
  15. [15]Nathan PW Smith MC. Spinal pathways subserving defaecation and sensation from the lower bowel. J Neurol Neurosurg Psychiatry 1953; 16: 245– 256 13109540 PMC503145
  16. [16]Nathan PW Smith MC. The centrifugal pathway for micturition within the spinal cord. J Neurol Neurosurg Psychiatry 1958; 21: 177– 189 13576168 PMC497316
  17. [17]Nathan PW Smith MC. The centripetal pathway from the bladder and urethra within the spinal cord. J Neurol Neurosurg Psychiatry 1951; 14: 262– 280 14898296 PMC499528
  18. [18]Bradley WE Timm GW Scott FB. Innervation of the detrusor muscle and urethra. Urol Clin North Am 1974; 1: 3– 27 4372763
  19. [19]De Groat WC. Neural control of the urinary bladder and large bowel. Integrative function of the autonomous nervous system 1979. North Holland: Elsevier; 50– 67
  20. [21]Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983; 33: 1444– 1452 6685237
  21. [22]Oppenheimer DR. The cervical cord in multiple sclerosis. Neuropathol Appl Neurobiol 1978; 4: 151– 162 683462
  22. [23]Kidd D Thorpe JW Thompson AJ Kendall BE Moseley IF MacManus DG. Spinal cord MRI using multi-array coils and fast spin echo. II. Findings in multiple sclerosis. Neurology 1993; 43: 2632– 2637 8255468
  23. [24]Kidd D Thorpe JW Kendall BE Barker GJ Miller DH McDonald WI. MRI dynamics of brain and spinal cord in progressive multiple sclerosis. J Neurol Neurosurg Psychiatry 1996; 60: 15– 19 8558143 PMC486183
  24. [25]Losseff NA Webb SL O’Riordan JI Page R Wang L Barker GJ. Spinal cord atrophy and disability in multiple sclerosis. A new reproducible and sensitive MRI method with potential to monitor disease progression. Brain 1996; 119 Pt 3 701– 708 8673483
  25. [26]Lycklama á Nijeholt GJ Castelijns JA Lazeron RH van Waesberghe JH Polman CH Uitdehaag BM. Magnetization transfer ratio of the spinal cord in multiple sclerosis: relationship to atrophy and neurologic disability. J Neuroimaging 2000; 10: 67– 72 10800258
  26. [27]Krogh K Christensen P Sabroe S Laurberg S. Neurogenic bowel dysfunction score. Spinal Cord 2006; 44: 625– 631 16344850
  27. [28]Ang D Talley NJ Simren M Janssen P Boeckxstaens G Tack J. Review article: endpoints used in functional dyspepsia drug therapy trials. Aliment Pharmacol Ther 2011; 33: 634– 649 21223343
  28. [29]Rahimi K Malhotra A Banning AP Jenkinson C. Outcome selection and role of patient reported outcomes in contemporary cardiovascular trials: systematic review. BMJ 2010; 341: c5707 21041324 PMC2967478
  29. [30]Paterson C. Measuring outcomes in primary care: a patient generated measure, MYMOP, compared with the SF-36 health survey. BMJ 1996; 312: 1016– 1020 8616351 PMC2350813
  30. [31]Talley NJ Phillips SF Melton J 3rd Wiltgen C Zinsmeister AR. A patient questionnaire to identify bowel disease. Ann Intern Med 1989; 111: 671– 674 2679285
  31. [32]Talley NJ Phillips SF Wiltgen CM Zinsmeister AR Melton LJ 3rd. Assessment of functional gastrointestinal disease: the bowel disease questionnaire. Mayo Clin Proc 1990; 65: 1456– 1479 2232900
  32. [33]Abrams P Cardozo L Fall M Griffiths D Rosier P Ulmsten U. The standardisation of terminology of lower urinary tract function: report from the Standardisation Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21: 167– 178 11857671
  33. [34]Krogh K Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Pract Res Clin Gastroenterol 2009; 23: 531– 543 19647688
  34. [35]Gore RM Mintzer RA Calenoff L. Gastrointestinal complications of spinal cord injury. Spine (Phila Pa 1976) 1981; 6: 538– 544 7336276
  35. [36]Glickman S Kamm MA. Bowel dysfunction in spinal-cord-injury patients. Lancet 1996; 347: 1651– 1653 8642958
  36. [37]Snooks SJ Swash M. Motor conduction velocity in the human spinal cord: slowed conduction in multiple sclerosis and radiation myelopathy. J Neurol Neurosurg Psychiatry 1985; 48: 1135– 1139 4078579 PMC1028573
  37. [38]Haldeman S Glick M Bhatia NN Bradley WE Johnson B. Colonometry, cystometry, and evoked potentials in multiple sclerosis. Arch Neurol 1982; 39: 698– 701 7125999
  38. [39]Glick ME Meshkinpour H Haldeman S Bhatia NN Bradley WE. Colonic dysfunction in multiple sclerosis. Gastroenterology 1982; 83: 1002– 1007 6288506
  39. [40]Kalsi V Fowler CJ. Therapy Insight: bladder dysfunction associated with multiple sclerosis. Nat Clin Pract Urol 2005; 2: 492– 501 16474623
  40. [41]Gill KP Chia YW Henry MM Shorvon PJ. Defecography in multiple sclerosis patients with severe constipation. Radiology 1994; 191: 553– 556 8153339
  41. [42]Mathers SE Ingram DA Swash M. Electrophysiology of motor pathways for sphincter control in multiple sclerosis. J Neurol Neurosurg Psychiatry 1990; 53: 955– 960 2178181 PMC488276
  42. [43]Waldron DJ Horgan PG Patel FR Maguire R Given HF. Multiple sclerosis: assessment of colonic and anorectal function in the presence of faecal incontinence. Int J Colorectal Dis 1993; 8: 220– 224 8163898
  43. [44]Wiesel PH Norton C Roy AJ Storrie JB Bowers J Kamm MA. Gut focused behavioural treatment (biofeedback) for constipation and faecal incontinence in multiple sclerosis. J Neurol Neurosurg Psychiatry 2000; 69: 240– 243 10896701 PMC1737071
  44. [45]Emmanuel AV Kamm MA. Response to a behavioural treatment, biofeedback, in constipated patients is associated with improved gut transit and autonomic innervation. Gut 2001; 49: 214– 219 11454797 PMC1728383

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Authors
Preziosi, G., Raptis, D. A., Raeburn, A., Thiruppathy, K., Panicker, J., & Emmanuel, A.
Affiliations
  • National Hospital for Neurology and Neurosurgery (GB)
  • University College London (GB)
Corresponding author
Emmanuel, Anton
ORCID
Venue
European Journal of Gastroenterology & Hepatology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-09
Volume
25
Issue
9
Pages
1044-1050
ISSN
0954-691X (ISSN-L)
DOI
10.1097/meg.0b013e328361eaf8
PMC
PMC4206376
OpenAlex
W1993056577
Cited by
51
References
0
Citations by year
2026: 3 · 2025: 4 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 6 · 2020: 4 · 2019: 2 · 2018: 5 · 2017: 2 · 2016: 3 · 2015: 3 · 2014: 3
FWCI
2.25
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • European Journal of Gastroenterology & Hepatology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Funders
Multiple Sclerosis Society
Topics
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Health Sciences › Medicine › Urology › Urinary Bladder and Prostate Research
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
Keywords
multiple sclerosis, gastrointestinal dysfunction, bowel dysfunction, bladder dysfunction, neurogenic bowel dysfunction, spinal cord disorders, patient-reported symptoms, symptom frequency and severity, Expanded Disability Status Scale, disability
MeSH terms
Adult, Urinary Bladder, Urinary Bladder, Neurogenic, Disability Evaluation, Female, Gastrointestinal Diseases, Humans, London, Male, Middle Aged, Predictive Value of Tests, Surveys and Questionnaires, Severity of Illness Index, Spinal Cord, Prevalence, Multiple Sclerosis, Chronic Progressive, Multiple Sclerosis, Relapsing-Remitting, Gastrointestinal Tract

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