Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease.
Gut dysfunction in patients with multiple sclerosis and the role of spinal cord involvement in the disease.
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DOI：
10.1097/meg.0b013e328361eaf8
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发表时间：
2013-09
影响因子：
2.1
通讯作者：
Emmanuel A
中科院分区：
文献类型：
--
作者：
Preziosi G;Raptis DA;Raeburn A;Thiruppathy K;Panicker J;Emmanuel A
肠道和膀胱症状在多发性硬化症（MS）患者中非常普遍。膀胱功能障碍（影响75%的患者）是由脊髓疾病引起的，而肠功能障碍的病理生理学尚不清楚。调节这两个器官的途径位于脊髓附近，它们功能障碍的共存可能是共同病理生理学的结果。如果是这样的话，膀胱症状的患病率应该在MS和肠道症状的患者中更高。这一假设在研究中得到验证。我们还评估了患者报告的症状如何量化肠功能障碍。在71例MS和肠道症状患者中记录了神经源性肠道功能障碍问卷和膀胱症状的存在。残疾，脊髓疾病的替代临床指标，使用扩展残疾状态量表进行评估。通过患者报告的频率量化肠道和膀胱症状，以时间百分比（感知症状时间的0、25、50、75或100%）表示，并在0至100之间的视觉模拟量表上对患者报告的严重程度进行量化。膀胱症状的患病率为85%，高于MS患者的预期患病率。神经源性肠功能障碍评分与患者报告的频率显著相关。与肠道症状严重程度（r =0.659，P=<0.0001）以及扩展残疾状态量表（r =0.526，P<0.0001）相关。我们的研究结果表明，MS患者的肠道功能障碍是继发于脊髓疾病。患者报告的肠道症状可以很好地量化肠功能障碍。
Bowel and bladder symptoms are highly prevalent in patients with multiple sclerosis (MS). Bladder dysfunction (affecting 75% of these patients) is caused by disease in the spinal cord, whilst the pathophysiology of bowel dysfunction is unknown. Pathways regulating both the organs lie in close proximity to the spinal cord, and coexistence of their dysfunction might be the result of a common pathophysiology. If so, the prevalence of bladder symptoms should be greater in patients with MS and bowel symptoms. This hypothesis is tested in the study. We also evaluated how patient-reported symptoms quantify bowel dysfunction. The Neurogenic Bowel Dysfunction questionnaire and the presence of bladder symptoms were recorded in 71 patients with MS and bowel symptoms. Disability, a surrogate clinical measure of spinal cord disease, was assessed using the Expanded Disability Status Scale. Bowel and bladder symptoms were quantified by patient-reported frequency, expressed in time percentage (0, 25, 50, 75 or 100% of the time the symptom was perceived), and patient-reported severity on a visual analogue scale between 0 and 100. The prevalence of bladder symptoms was 85%, which is higher than that expected in an unselected population of patients with MS. Neurogenic Bowel Dysfunction score was significantly correlated with both patient-reported frequency (r=0.860, P<0.0001) and severity of bowel symptoms (r=0.659, P=<0.0001), as well as with the Expanded Disability Status Scale (r=0.526, P<0.0001). Our findings suggest that gut dysfunction in patients with MS is secondary to spinal cord disease. Patient-reported bowel symptoms quantify bowel dysfunction well.