Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: a 14-year cohort study
Abstract
Background Multiple sclerosis (MS) is an autoimmune, neurodegenerative disease frequently complicated by bowel symptoms. Multiple sclerosis typically first manifests with a demyelination event, also known as a clinically isolated syndrome (CIS). We sought to examine the prevalence of prodromal bowel symptoms predating a CIS in patients with MS as part of a recently characterized prodromal phase of disease. Methods We constructed a retrospective cohort of MS patients with bowel symptoms and an identifiable CIS at two tertiary care centers over 14 years using administrative and billing data. We determined the date of onset of reported bowel symptoms in comparison with the date of first CIS and determined the overall prevalence of prediagnosis bowel symptoms within 1, 2, 3, and >3 years from a CIS. We used multivariable modeling to determine demographic and clinical risk factors for prediagnosis bowel symptoms. Key results Among 385 MS patients with reported bowel symptoms, 122 (31.6%) reported bowel symptoms prior to CIS. The most common first bowel symptom was constipation (50.0%), followed by diarrhea (29.5%). The average lead time between a first bowel symptom and a CIS event was 3.7 ± 3.4 years. Pre-CIS fatigue (OR 4.48, 95% CI: 2.68-7.51, P Conclusions and inferences Nearly a third of MS patients with bowel symptoms reported bowel symptoms prior to a demyelinating event/CIS. Characterization of a prodromal phase of disease may provide important insights into understanding…
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In multiple sclerosis, both slow transit and defecatory dyssynergia contribute to bowel symptoms.
“Objective studies using anorectal manometry, transit testing, and validated symptom instruments demonstrate that both slow transit and defecatory dyssynergia contribute to symptoms in MS, with severity often tracking neurologic disability (Almeida et al., 2019; Lin et al., 2019; Marola et al., 2016; Preziosi et al., 2014; Weber et al., 1987; Wiesel et al., 2000).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Almeida et al., 2019
Bowel symptoms are common across multiple sclerosis disease phenotypes.
“and bowel symptoms are common across disease phenotypes.”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Almeida et al., 2019
In multiple sclerosis, constipation, fecal incontinence, and evacuation disorders often co-occur with bladder dysfunction.
“Constipation, fecal incontinence, and evacuation disorders often co-occur with bladder dysfunction and can significantly impair quality of life (Almeida et al., 2019; Hinds et al., 1989; Lin et al., 2019).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Almeida et al., 2019
In multiple sclerosis, constipation, fecal incontinence, and evacuation disorders can significantly impair quality of life.
“Constipation, fecal incontinence, and evacuation disorders often co-occur with bladder dysfunction and can significantly impair quality of life (Almeida et al., 2019; Hinds et al., 1989; Lin et al., 2019).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Almeida et al., 2019
In multiple sclerosis, bowel symptom severity often tracks neurologic disability.
“Objective studies using anorectal manometry, transit testing, and validated symptom instruments demonstrate that both slow transit and defecatory dyssynergia contribute to symptoms in MS, with severity often tracking neurologic disability (Almeida et al., 2019; Lin et al., 2019; Marola et al., 2016; Preziosi et al., 2014; Weber et al., 1987; Wiesel et al., 2000).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Almeida et al., 2019
Cites
The bowel and beyond: The enteric nervous system in neurological disorders
Rao, M., & Gershon, M. D. (2016) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/nrgastro.2016.107 · Cited by 629 · see citing works
Relationships Between Multiple Sclerosis and Depression
Byatt, N., Rothschild, A. J., Riskind, P., Ionete, C., & Hunt, A. T. (2011) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/jnp.23.2.jnp198 · Cited by 51 · see citing works
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Gastrointestinal motility disorders in neurologic disease
Camilleri, M. (2021) · Journal of Clinical Investigation · doi:10.1172/jci143771 · Cited by 211 · see citing works
Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction
Shouman, K., Camilleri, M., & Singer, W. (2026) · Autonomic Neuroscience · doi:10.1016/j.autneu.2026.103474
- Authors
- Almeida, M. N., Silvernale, C., Kuo, B., & Staller, K.
- Affiliations
- Harvard University (US)
- Corresponding author
- Staller, Kyle
- Venue
- Neurogastroenterology & Motility
- Publisher
- Wiley
- Published
- 2019-04-08
- Volume
- 31
- Issue
- 6
- Pages
- e13592-e13592
- ISSN
- 1350-1925 (ISSN-L)
- 1365-2982
- OpenAlex
- W2936288918
- Cited by
- 34
- References
- 2
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 3 · 2023: 8 · 2022: 6 · 2021: 4 · 2020: 3 · 2019: 1
- FWCI
- 2.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Neurogastroenterology & Motility (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
- Keywords
- multiple sclerosis, bowel symptoms, prodromal symptoms, clinically isolated syndrome, constipation, diarrhea, fatigue, sensory disturbances, disease progression, demyelination, risk factors
- MeSH terms
- Adult, Female, Humans, Intestinal Diseases, Male, Multiple Sclerosis, Retrospective Studies, Cohort Studies, Prevalence, Prodromal Symptoms
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