Gastrointestinal conditions in the multiple sclerosis prodrome

Area of Science:

• Neurology
• Gastroenterology
• Epidemiology

Background:

• Multiple Sclerosis (MS) is a chronic neurological disease with a complex etiology.
• Gastrointestinal (GI) dysfunction is frequently reported in MS patients, but its role in the disease's early stages is less understood.

Purpose of the Study:

• To examine the association between GI-related physician visits and drug dispensations in the five years preceding a first demyelinating event or MS onset.
• To investigate potential sex differences in GI symptom presentation before MS diagnosis.

Main Methods:

• Utilized linked administrative and clinical data from British Columbia (1996-2013).
• Identified an administrative cohort (n=6863) and a clinical cohort (n=966) of MS cases, with matched controls.
• Compared GI-related physician visits and drug dispensations in the five years prior to the index date using negative binomial and robust Poisson models.

Main Results:

• MS cases showed significantly higher rates of physician visits for gastritis, duodenitis, and esophageal diseases.
• MS cases had a greater risk of dispensations for constipation-related medications, antiemetics, and propulsives.
• Men exhibited a disproportionally higher relative risk for propulsive drug dispensations compared to women.

Conclusions:

• GI-related physician visits and drug dispensations are more common in the five years preceding a first demyelinating event or MS onset.
• GI symptoms represent a measurable feature of the prodromal or early phase of MS.
• A sex difference in GI symptom presentation during the early stages of MS is evident.