The Impact of Multiple Sclerosis on Gastrointestinal System Function

Abstract

MS patients commonly experience symptoms related to dysregulated gastrointestinal function, and these problems contribute to significant impairment in quality of life. Oropharyngeal dysphagia and anorectal dysfunction have traditionally garnered the most attention due to their more obvious impacts on daily functions. For example, convergent evidence suggests a prevalence of oropharyngeal dysphagia in 25–40 % of all MS patients. Similarly, anorectal dysfunction is quite common with ~40 % of MS patients reporting constipation and ~25 % reporting frequent fecal incontinence. In addition, many MS patients experience mixed forms of anorectal dysfunction with both constipation and fecal incontinence. There are a diverse range of potential pathophysiological mechanisms that contribute to these problems, including general impairments in skeletal motor function that are typically experienced by MS patients. However, recent research has revealed that gastrointestinal symptoms in the MS population are not limited to oropharyngeal dysphagia and anorectal dysfunction, but include dyspepsia and abdominal pain. The latter associations may reveal a broader impact of MS disease beyond impairments in skeletal motor function to include disruptions in the central neural regulation of autonomic and/or sensory processing. Despite the significant impact of gastrointestinal dysfunction on MS patient quality of life, there remains a paucity of published literature on therapeutic options for these disorders in this patient population. Thus, there is a compelling need to develop effective treatment options that should translate into improved patients’ quality of life. Collaborative work between neurologists and gastroenterologists will have the best chance to advance the field and to optimize the care of MS patients suffering from symptoms related to impaired gastrointestinal function.