Multiple sclerosis and inflammatory bowel diseases: a systematic review and meta-analysis

Abstract

The association between multiple sclerosis (MS) and inflammatory bowel disease (IBD) has been suggested, apart from their common epidemiological and immunological patterns, also due to observations of increased incidence of both IBD among MS patients and MS among IBD patients. We estimated the risk of concurrent IBD and MS comorbidity, using data from all available case-control studies. We calculated the corresponding Risk ratios (RRs) in each included case-control study to express the risk of IBD and MS concurrence at a given population. We performed additional subgroup analyses according to the type of registry from which the data of the cases were exported (IBD or MS registry) and the IBD type (Crohn's disease, CD or Ulcerative colitis, UC). We included 10 studies, comprising a total of 1,086,430 patients (0.08% of them with concurrent IBD and MS). Pooled RR for IBD/MS comorbitity was 1.54 (95% CI 1.40-1.67; p < 0.0001) with no differences (p = 0.91) among IBD and MS registries (RR 1.53, 95% CI 1.36-1.72, p < 0.001 for MS comorbidity in IBD patients vs. RR 1.55, 95% CI 1.32-1.81, p < 0.001 for IBD comorbidity in MS patients). No difference was also found on the risk of MS comorbidity among patients with CD or UC (RR 1.52, 95% CI 1.34-1.72, p < 0.001 vs. RR 1.55, 95% CI 1.38-1.74, p < 0.001; p for subgroup differences: 0.84). In all analyses no evidence of heterogeneity or publication bias was detected. Both IBD and MS patients seem to have a fifty-percent increased risk of MS or IBD comorbidity, respectively, with no apparent differences between patients with CD or UC.

Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: A 14‐year cohort study

“…Among these bowel symptoms, constipation was the most common, consistent with patients' complaints after disease diagnosis, where constipation is also most commonly reported. 1 Despite finding a relatively high prevalence of inflammatory bowel disease in this cohort in line with other studies, 19 the majority of prediagnosis bowel complaints would not be considered inflammatory.…”

Microbiome–microglia connections via the gut–brain axis

“…Patients with MS have high levels of intestinal permeability. Yacyshyn et al, 1996;Benveniste, 1997;Heppner et al, 2005;Sun et al, 2006;Piccio et al, 2007;Yokote et al, 2008;Frischer et al, 2009;Napoli and Neumann, 2010;Vogel et al, 2013;Miyake et al, 2015;Cekanaviciute et al, 2017;Gao et al, 2017;Kosmidou et al, 2017;Luo et al, 2017 Activated microglia produce reactive oxygen species that contribute to oxidative stress and heightened neuronal injury, neurodegeneration, and demyelination. delivery, antibiotic use, and early-age infections increase an individual's predisposition to atypical behavioral patterns.…”

Neurological Manifestations of Inflammatory Bowel Disease

“…MS patients have a higher risk of sufering from associated IBD) [36]. These authors found an increased risk of 50% [36].…”

“…Rang et al described a higher prevalence of multiple sclerosis (MS) than expected in UC patients [33]. Subsequently, this inding has been conirmed by many reports, but not only for UC but also for CD [34][35][36]. For instance, Gupta et al described an increased risk of optic neuritis and other forms of MS in CD (odds ratio = 1.54) and UC (odds ratio = 1.75) [35].…”

“…In the same line, a recent meta-analysis concluded that IBD patients present a higher risk of sufering from concomitant MS and vice versa (i.e. MS patients have a higher risk of sufering from associated IBD) [36]. These authors found an increased risk of 50% [36].…”