The authors suggest that recognizing the possible link may help identify patients at greater risk, although they do caution that larger studies are needed.
A case report of a patient with both multiple sclerosis (MS) and Crohn disease is highlighting the view that clinicians should pay attention to the possibility of an association between MS and inflammatory bowel disease (IBD).
While the estimated prevalence of MS in the general population is 0.1%, the prevalence of the disease jumps to 0.5% in patients with IBD, suggesting a 1.5 to 5-fold increase in the risk of developing MS in patients with IBD. The researchers of the case report argue that recognizing this association may help identify patients at greater risk, although they do warn that future, larger studies are needed.
“The association between multiple sclerosis (MS) and inflammatory bowel disease (IBD), has been supposed for decades,” wrote the researchers. “Emerging literature suggests that this relationship is far more common and is likely underreported. Both diseases appear to share common immunological and epidemiological similarities.”
The 41-year-old man presented to the hospital with chronic diarrhea and weakness. Magnetic resonance imaging of the brain and spine revealed an advanced demyelinating process in the brain and the mid- and lower-cervical spinal levels of the spinal cord. The MS diagnosis was made after cerebrospinal fluid cytology showed red-blood cells of 3, glucose of 70, white blood cells of 0, and a protein level of 53 with immunoglobulin G oligoclonal bands.
Based on colonoscopy and esophagogastroduodenoscopy results, the patient was also diagnosed with Crohn disease, one of the 2 main types of IBD.
“The relationship between MS and IBD was first suggested by Rang et al. in 1982; the prevalence of MS was approximately three-fold higher in patients who had undergone a colectomy for the treatment of IBD,” wrote the authors. “Similarly, a retrospective study also detected an increased incidence of demyelinating disease among patients with IBD, and especially among patients with [ulcerative colitis].”
According to the authors, both diseases appear to have both immunological and epidemiological similarities. And while both diseases have an ill understood etiology, genetic predisposition, disruption of the intestinal microbial flora, and the immune system of the gastrointestinal tract may play significant roles.
Dziadkowiec K, Stawinski P, Radadiya D, Abbasi B, Isaac S. Is multiple sclerosis an extra-intestinal manifestation of inflammatory bowel disease? Food for thought. Cureus. Published online July 30, 2020. doi: 10.7759/cureus.9485.