CoChat
Sign Up
Cited by 93Gastrointestinal motility and disordersMultiple Sclerosis Research StudiesInflammatory Bowel Disease

Adding to the Burden: Gastrointestinal Symptoms and Syndromes in Multiple Sclerosis

Open access
Levinthal, David J., Rahman, Ambreen, Nusrat, Salman, O’Leary, Margie, Heyman, Rock, Bielefeldt, Klaus·2013·Multiple Sclerosis International
DOI 10.1155/2013/319201PMC PMC3791579
Open this paper in CoChat — free accountOpen PDF

Abstract

Background . Multiple sclerosis (MS) patients often suffer from gastrointestinal (GI) symptoms. However, the full extent and prevalence of such symptoms are not clearly established. Thus, we sought to define the prevalence of GI symptoms and syndromes in those with MS. Methods . 218 MS patients completed self-reported demographic and clinical data questionnaires as well as several standardized surveys probing MS severity and GI health. Results . Nearly two thirds (65.6%) of patients endorsed at least one persistent GI symptom. Constipation (36.6%), dysphagia (21.1%), and fecal incontinence (15.1%) were common. Surprisingly, nearly 30% (28.4%) of the patients reported dyspeptic symptoms. Using validated diagnostic algorithms, patients met criteria for functional dysphagia (14.7%), functional dyspepsia (16.5%), functional constipation (31.7%), and IBS (19.3%), among others. Functional dysphagia, functional dyspepsia, and IBS were significantly more common in those with self-identified mood disorders. Conclusions . Constipation, fecal incontinence, and dysphagia are indeed frequent symptoms seen in MS patients. We also noted a ~30% prevalence of dyspepsia in this population. The mechanisms driving this association are not clear and require further study. However, due to this high prevalence, dyspeptic symptoms should be incorporated into the routine assessment of MS patients and, if found, may warrant collaborative referral with a GI specialist.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1155/2013/319201

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 57

  1. [1]Kurtzke JF Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS) Neurology 1983 33 11 1444 1452 2-s2.0-0021035886 6685237
  2. [2]Bergamaschi R Crivelli P Rezzani C The DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis Journal of the Neurological Sciences 2008 269 1-2 49 53 2-s2.0-43049133531 18280504
  3. [3]Nusrat S Gulick E Levinthal D Bielefeldt K Anorectal dysfunction in multiple sclerosis: a systematic review ISRN Neurology 2012 2012 9 pages 376023 PMC3414061 22900202
  4. [4]Hinds JP Eidelman BH Wald A Prevalence of bowel dysfunction in multiple sclerosis. A population Survey Gastroenterology 1990 98 6 1538 1542 2-s2.0-0025219419 2338192
  5. [5]Alkhawajah M Oger J When to initiate disease-modifying drugs for relapsing remitting multiple sclerosis in adults? Multiple Sclerosis International 2011 2011 11 pages 724871 PMC3195775 22096641
  6. [6]Hobart J Lamping D Fitzpatrick R Riazi A Thompson A The multiple sclerosis impact scale (MSIS-29) a new patient-based outcome measure Brain 2001 124 5 962 973 2-s2.0-0035010231 11335698
  7. [7]Drossman DA Drossman DA Corazziari E Delvaux M The functional gastrointestinal disorders and the Rome III process Rome III: The Functional Gastrointestinal Disorders 2006 3rd edition McLean, Va, USA Degnon Associates 1 29
  8. [8]Chen AY Frankowshi R Bishop-Leone J The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M. D. Anderson dysphagia inventory Archives of Otolaryngology—Head and Neck Surgery 2001 127 7 870 876 2-s2.0-0034936244 11448365
  9. [9]Rockwood TH Church JM Fleshman JW Patient and surgeon ranking of the severity of symptoms associated with fecal incontinence: the fecal incontinence severity index Diseases of the Colon and Rectum 1999 42 12 1525 1532 2-s2.0-0033407077 10613469
  10. [10]Kumar R Approved and investigational uses of modafinil: an evidence-based review Drugs 2008 68 13 1803 1839 2-s2.0-50249113719 18729534
  11. [11]Mcdonald S Clements JN Dalfampridine: a new agent for symptomatic management of multiple sclerosis American Journal of Health-System Pharmacy 2011 68 24 2335 2340 2-s2.0-83755177674 22135060
  12. [12]Blanchard EB Scharff L Schwarz SP Suls JM Barlow DH The role of anxiety and depression in the irritable bowel syndrome Behaviour Research and Therapy 1990 28 5 401 405 2-s2.0-0025176030 2256898
  13. [13]Henningsen P Zimmermann T Sattel H Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review Psychosomatic Medicine 2003 65 4 528 533 2-s2.0-0041843834 12883101
  14. [14]van Oudenhove L Vandenberghe J Vos R Fischler B Demyttenaere K Tack J Abuse history, depression, and somatization are associated with gastric sensitivity and gastric emptying in functional dyspepsia Psychosomatic Medicine 2011 73 8 648 655 2-s2.0-80053929455 21949416
  15. [15]Wood LD Neumiller JJ Setter SM Dobbins EK Clinical review of treatment options for select nonmotor symptoms of Parkinson’s disease The American Journal Geriatric Pharmacotherapy 2010 8 4 294 315 2-s2.0-77957262214 20869620
  16. [16]Pfeiffer RF Gastrointestinal dysfunction in Parkinson’s disease Parkinsonism and Related Disorders 2011 17 1 10 15 2-s2.0-78651096332 20829091
  17. [17]Tang S Dimberg EL Milone M Wong LJC Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE)-like phenotype: an expanded clinical spectrum of POLG1 mutations Journal of Neurology 2012 259 5 862 868 2-s2.0-80053636638 21993618
  18. [18]Isono C Hirano M Sakamoto H Ueno S Kusunoki S Nakamura Y Differences in Dysphagia between spinocerebellar ataxia type 3 and type 6 Dysphagia 2013 28 3 413 418 23515636
  19. [19]Rofes L Vilardell N Clavé P Post-stroke dysphagia: progress at last Neurogastroenterology & Motility 2013 25 278 282 23480388
  20. [20]Donovan NJ Daniels SK Edmiaston J Dysphagia screening: state of the art: invitational conference proceeding from the State-of-the-Art Nursing Symposium, International Stroke Conference 2012 Stroke 2013 44 4 e24 e31 23412377
  21. [21]Hennessey A Robertson NP Swingler R Compston DA Urinary, faecal and sexual dysfunction in patients with multiple sclerosis Journal of Neurology 1999 246 11 1027 1032 2-s2.0-0032705150 10631634
  22. [22]DasGupta R Fowler CJ Bladder, bowel and sexual dysfunction in multiple sclerosis: management strategies Drugs 2003 63 2 153 166 2-s2.0-0037250876 12515563
  23. [23]Porter CK Gormley R Tribble DR Cash BD Riddle MS The incidence and gastrointestinal infectious risk of functional gastrointestinal disorders in a healthy US adult population American Journal of Gastroenterology 2011 106 1 130 138 2-s2.0-78650978167 20859264
  24. [24]Chang JY Locke GR III McNally MA Impact of functional gastrointestinal disorders on survival in the community American Journal of Gastroenterology 2010 105 4 822 832 2-s2.0-77950519595 20160713 PMC2887253
  25. [25]Locke GR III Zinsmeister AR Fett SL Melton LJ III Talley NJ Overlap of gastrointestional symptom complexes in a US community Neurogastroenterology and Motility 2005 17 1 29 34 2-s2.0-13444269490 15670261
  26. [26]Poorjavad M Derakhshandeh F Etemadifar M Soleymani B Minagar A Maghzi A-H Oropharyngeal dysphagia in multiple sclerosis Multiple Sclerosis 2010 16 3 362 365 2-s2.0-77949895891 20203150
  27. [27]Bergamaschi R Rezzani C Minguzzi S Validation of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis Functional Neurology 2009 24 3 159 162 2-s2.0-77951230180 20018144
  28. [28]Nusrat S Nusrat S Bielefeldt K Reflux and sex: what drives testing, what drives treatment? European Journal of Gastroenterology and Hepatology 2012 24 3 233 247 2-s2.0-84856709575 22186188
  29. [29]Sørensen M Lorentzen M Petersen J Christiansen J Anorectal dysfunction in patients with urologic disturbance due to multiple sclerosis Diseases of the Colon and Rectum 1991 34 2 136 139 2-s2.0-0026013232 1993411
  30. [30]Chiarioni G Salandini L Whitehead WE Biofeedback benefits only patients with outlet dysfunction, not patients with isolated slow transit constipation Gastroenterology 2005 129 1 86 97 2-s2.0-22344452215 16012938
  31. [31]Weber J Grise P Roquebert M Radiopaque markers transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction Diseases of the Colon and Rectum 1987 30 2 95 100 2-s2.0-0023099048 3803128
  32. [32]Mathers SE Ingram DA Swash M Electrophysiology of motor pathways for sphincter control in multiple sclerosis Journal of Neurology Neurosurgery and Psychiatry 1990 53 11 955 960 2-s2.0-0025000112 PMC488276 2178181
  33. [33]Waldron DJ Horgan PG Patel FR Maguire R Given HF Multiple sclerosis: assessment of colonic and anorectal function in the presence of faecal incontinence International Journal of Colorectal Disease 1993 8 4 220 224 2-s2.0-0027763546 8163898
  34. [34]Chia Y-W Fowler CJ Kamm MA Henry MM Lemieux MC Swash M Prevalence of bowel dysfunction in patients with multiple sclerosis and bladder dysfunction Journal of Neurology 1995 242 2 105 108 2-s2.0-0028859109 7707085
  35. [35]Nordenbo AM Andersen JR Andersen JT Disturbances of ano-rectal function in multiple sclerosis Journal of Neurology 1996 243 6 445 451 2-s2.0-0030008612 8803816
  36. [36]Shahid S Ramzan Z Maurer AH Parkman HP Fisher RS Chronic idiopathic constipation: more than a simple colonic transit disorder Journal of Clinical Gastroenterology 2012 46 2 150 154 2-s2.0-84855767026 22011587
  37. [37]Whitehead WE Borrud L Goode PS Fecal Incontinence in US Adults: epidemiology and risk factors Gastroenterology 2009 137 2 512 517 2-s2.0-67651093963 19410574 PMC2748224
  38. [38]Mak AD Wu JC Chan Y Chan FK Sung JJ Lee S Dyspepsia is strongly associated with major depression and generalised anxiety disorder: a community study Alimentary Pharmacology & Therapeutics 2012 36 800 810 22957985
  39. [39]Popescu BF Lennon VA Parisi JE Neuromyelitis optica unique area postrema lesions: nausea, vomiting, and pathogenic implications Neurology 2011 76 14 1229 1237 2-s2.0-79954583376 21368286 PMC3068006
  40. [40]Reddymasu SC Bonino J McCallum RW Gastroparesis secondary to a demyelinating disease: a case series BMC Gastroenterology 2007 7, article 3 2-s2.0-33847204060 PMC1800858 17266755
  41. [41]Raghav S Kipp D Watson J Spring W Gastroparesis with multiple sclerosis Multiple Sclerosis 2006 12 2 243 244 2-s2.0-33645811525 16629430
  42. [42]Jongen PJ Sindic C Sanders E Adverse events of interferon beta-1a: a prospective multi-centre international ICH-GCP-based CRO-supported external validation study in daily practice PLoS One 2011 6 10 2-s2.0-80055056685 e26568 PMC3201962 22046309
  43. [43]O’Connor P Wolinsky JS Confavreux C Randomized trial of oral teriflunomide for relapsing multiple sclerosis The New England Journal of Medicine 2011 365 14 1293 1303 2-s2.0-80053533877 21991951
  44. [44]Truini A Galeotti F La Cesa S Mechanisms of pain in multiple sclerosis: a combined clinical and neurophysiological study Pain 2012 153 2048 2054 22789132
  45. [45]Elsenbruch S Rosenberger C Bingel U Forsting M Schedlowski M Gizewski ER Patients with irritable bowel syndrome have altered emotional modulation of neural responses to visceral stimuli Gastroenterology 2010 139 4 1310 1319 2-s2.0-77957351785 20600024
  46. [46]Naliboff BD Munakata J Fullerton S Evidence for two distinct perceptual alterations in irritable bowel syndrome Gut 1997 41 4 505 512 2-s2.0-9844248527 9391250 PMC1891510
  47. [48]Lackner JM Quigley BM Pain catastrophizing mediates the relationship between worry and pain suffering in patients with irritable bowel syndrome Behaviour Research and Therapy 2005 43 7 943 957 2-s2.0-19344362715 15896288
  48. [49]Sjonnesen K Berzins S Fiest KM Evaluation of the 9-item patient health questionnaire (PHQ-9) as an assessment instrument for symptoms of depression in patients with multiple sclerosis Postgraduate Medical 2012 124 69 77 23095427
  49. [50]Moore P Hirst C Harding KE Clarkson H Pickersgill TP Robertson NP Multiple sclerosis relapses and depression Journal of Psychosomatic Research 2012 73 272 276 22980532
  50. [51]Strober LB Christodoulou C Benedict RH Unemployment in multiple sclerosis: the contribution of personality and disease Multiple Sclerosis 2012 18 5 647 653 2-s2.0-84860456188 22183935
  51. [52]Krokavcova M Nagyova I Rosenberger J Employment status and perceived health status in younger and older people with multiple sclerosis International Journal of Rehabilitation Research 2012 35 1 40 47 2-s2.0-84857193124 22143555
  52. [53]Sonder JM Bosma L van der Linden FAH Knol DL Polman CH Uitdehaag BMJ Proxy measurements in multiple sclerosis: agreement on different patient-reported outcome scales Multiple Sclerosis 2012 18 2 196 201 2-s2.0-84856700136 21908479
  53. [54]Bosma L Kragt J Polman C Walking speed, rather than expanded disability status scale, relates to long-term patient-reported impact in progressive MS Multiple Sclerosis Journal 2013 19 326 333 22907939
  54. [55]Motl RW McAuley E Wynn D Sandroff B Suh Y Physical activity, self-efficacy, and health-related quality of life in persons with multiple sclerosis: analysis of associations between individual-level changes over one year Quality of Life Research 2013 22 2 253 261 2-s2.0-84857698806 22403041
  55. [56]Jones K Ford D Jones P The physical and psychological impact of multiple sclerosis using the MSIS-29 via the web portal of the UK MS register PLoS One 2013 8 e55422 PMC3561202 23383186
  56. [57]Chang F Chen P Wu T Prevalence of functional gastrointestinal disorders in Taiwan: questionnaire-based survey for adults based on the Rome III criteria Asia Pacific Journal of Clinical Nutrition 2012 21 594 600 23017318
  57. [58]Aro P Talley NJ Agréus L Functional dyspepsia impairs quality of life in the adult population Alimentary Pharmacology and Therapeutics 2011 33 11 1215 1224 2-s2.0-79955587635 21443537

Cited by

Sorted by citations

Authors
Levinthal, D. J., Rahman, A., Nusrat, S., O’Leary, M., Heyman, R., & Bielefeldt, K.
Affiliations
  • University of Pittsburgh Medical Center (US)
  • University of Oklahoma Health Sciences Center (US)
  • Neuroimmunology/Multiple Sclerosis Division, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
Corresponding author
Levinthal, David J.
ORCID
Venue
Multiple Sclerosis International
Publisher
Wiley
Published
2013
Volume
2013
Pages
1-9
ISSN
  • 2090-2654 (ISSN-L)
  • 2090-2662
DOI
10.1155/2013/319201
PMC
PMC3791579
OpenAlex
W2098513014
Cited by
93
References
1
Citations by year
2026: 5 · 2025: 10 · 2024: 4 · 2023: 8 · 2022: 14 · 2021: 13 · 2020: 5 · 2019: 8 · 2018: 6 · 2017: 7 · 2016: 3 · 2015: 7 · 2014: 3
FWCI
4.09
Type
journal article
Language
en
Open access
Licence
Locations
  • Multiple Sclerosis International (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Ethel Vincent Charitable Trust
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Multiple Sclerosis Research Studies
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Inflammatory Bowel Disease
Keywords
multiple sclerosis, gastrointestinal symptoms, constipation, dysphagia, fecal incontinence, functional dyspepsia, irritable bowel syndrome, functional constipation, mood disorders, prevalence, symptom burden

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review