Related Experiment Video
Updated: Jan 26, 2026
The Multiple Sclerosis Performance Test MSPT: An iPad-Based Disability Assessment Tool
Published on: June 30, 2014
Bowel symptoms predate the diagnosis among many patients with multiple sclerosis: A 14-year cohort study
Mariana N Almeida1,2, Casey Silvernale1,2, Braden Kuo1,2
1Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
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 < 0.001) and pre-CIS sensory disturbances (OR 1.88, 95% CI: 1.15-3.08, P < 0.05) were all associated with bowel symptoms prior to a CIS event.
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 disease progression.
Insights
Nearly one-third of multiple sclerosis (MS) patients experienced bowel symptoms before their first neurological event. This suggests a potential prodromal phase in MS, offering new insights into disease progression.
Area of Science:
- Neurology
- Gastroenterology
- Immunology
Background:
- Multiple sclerosis (MS) is a neurodegenerative autoimmune disease.
- Bowel symptoms are common complications in MS patients.
- A clinically isolated syndrome (CIS) often precedes MS diagnosis.
Purpose of the Study:
- To investigate the prevalence of prodromal bowel symptoms before a CIS in MS patients.
- To characterize the nature and timing of these pre-CIS bowel symptoms.
- To identify risk factors associated with early bowel symptom onset in MS.
Main Methods:
- Retrospective cohort study of 385 MS patients with bowel symptoms.
- Analysis of administrative and billing data from two tertiary care centers over 14 years.
- Multivariable modeling to assess demographic and clinical risk factors for pre-CIS bowel symptoms.
Main Results:
- 31.6% of MS patients reported bowel symptoms before their CIS.
- Constipation (50.0%) and diarrhea (29.5%) were the most frequent initial bowel symptoms.
- Pre-CIS fatigue and sensory disturbances were significantly associated with earlier bowel symptoms.
Conclusions:
- A substantial proportion of MS patients experience bowel symptoms before diagnosis.
- Identifying these prodromal symptoms may enhance understanding of MS pathogenesis.
- Further research into the MS prodromal phase could inform early detection and intervention strategies.
Related Concept Videos
01:15Diabetes: Symptoms, Diagnosis, and Complications
02:39Predator-Prey Interactions
01:24Nursing Process for Patient and Caregiver Teaching I: Assessment and Diagnosis
It is critical to determine the patient's learning needs during the assessment. Determination of learning needs compounds data...
01:11Bioavailability Study Design: Single Versus Multiple Dose Studies
01:30Negative and Cognitive Symptoms of Schizophrenia
Negative Symptoms
Negative symptoms of schizophrenia manifest as deficits in normal emotional and behavioral functioning, profoundly impacting daily life. Individuals with schizophrenia often display a flat affect, characterized by a near-total absence of emotional expression,...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the...