Inflammatory bowel disease (IBD) and multiple sclerosis (MS) share certain features in common. Both are considered to be immune-mediated, inflammatory diseases. The cause of both conditions remains unknown, though both have been linked to genetic and environmental factors, as well as disruptions of the gut microbiome . They also share a number of risk factors, and both can cause bowel problems.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d5f9bf71-a415-4361-a1db-aecf8cea5b0e The two conditions have long been thought to be linked in some way, but the nature of the exact connection remains elusive. Although studies have found that people with one of these conditions are at a higher risk than the general population of having the other as well, it’s relatively rare for a person to be diagnosed with both.e60dc2a1-f33c-4a05-9b50-8e3e8e597629259febd1-7b99-4fd7-9acd-2932adb1cd13
Prevalence of MS and IBD Prevalence According to a systematic review and meta-analysis of 17 studies, the prevalence of MS in patients with IBD was 0.2 percent, while the prevalence of IBD in patients with MS was 0.6 percent. Patients with MS had a higher prevalence of IBD than those in a control group (researchers found a similarly high risk of developing Crohn’s disease or ulcerative colitis), and patients with IBD had a higher prevalence of MS than those in the control group.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f586efa1-2312-4fcb-aa8a-b0969099c770 “We don’t know how to predict who with IBD is going to get MS or vice versa, but it’s something doctors need to think about when we’re prescribing medications or treatments,” says Gil Melmed, MD , director of inflammatory bowel disease clinical research at Cedars-Sinai Medical Center in Los Angeles. “While it’s not common to have both MS and IBD, having one of these conditions is a risk factor for having the other,” adds Brian Barry, MD , attending neurologist at MedStar Washington Hospital Center in Washington, DC. Dr. Barry notes that he has seen several patients with both conditions.
What Is IBD? What Is IBD? IBD refers to a group of conditions, the most common of which are ulcerative colitis (UC) and Crohn’s disease (CD) . UC and CD typically affect different parts of the digestive tract, but they both lead to similar symptoms, including abdominal pain, diarrhea, gas, and nausea, which occur episodically.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291628ac29-5faa-46ac-aad6-05c1b238a2a4 IBD is often referred to as an autoimmune disease, but Dr. Melmed prefers the term immune-mediated. “In IBD, the body is not attacking itself per se, but the immune system is being triggered by bacteria commonly found in the gut and going into overdrive,” he explains.
What Is MS? What Is MS? In MS on the other hand, it’s generally thought that the immune system attacks the protective sheath, or myelin, around nerve fibers, which causes communication problems between your brain and the rest of your body. Over time, it can cause permanent damage to the nerve fibers. Signs and symptoms of MS vary widely depending on the location and severity of nerve fiber damage but commonly include numbness or weakness in one or more limbs, tingling, lack of coordination or trouble walking, vision disturbances, and problems with sexual, bowel, and bladder function, among others.e60dc2a1-f33c-4a05-9b50-8e3e8e597629486b6fd8-8049-4c84-b11f-4f4c1ee100f2
IBD and MS: Some Overlapping Symptoms Common Symptoms Bowel symptoms similar to those caused by IBD are common in MS, though just how common isn’t well established. A study published in 2023 examined data from 369 people with MS and found that just under half of them reported bowel symptoms.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b164614c-9c39-4fcf-bd1c-69b27ffe319f Meanwhile, the MS Society UK states that 7 out of 10 people with MS experience bowel symptoms. Constipation is commonly among them, though the opposite, loose stools, can also occur.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fa7d454c-17cf-40d5-9131-2baa115abf9a Likewise, IBD can be a risk factor for neurological complications similar to those seen in MS, including damage to myelin, though these complications are rarely reported, as both Melmed and Barry point out.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b80656a2-b2c6-4cfc-8704-b82a52549c8f In one case study, researchers speculated that in a patient with both UC and a condition called transverse myelitis, which is similar to MS but only involves the spinal cord, the transverse myelitis was a manifestation of UC outside of the intestine.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e9d3234-c4b2-4d4c-8c8d-0d14b9c59ecde60dc2a1-f33c-4a05-9b50-8e3e8e5976299756d841-9831-4c76-9703-a07c71c700b2 Melmed adds, “This is just a single report, and this condition is not widely considered to be an extraintestinal manifestation of IBD — and if it is, it would be extraordinarily rare.”
How Are IBD and MS Connected? Gut-Brain Axis Researchers don’t yet fully understand the exact connection between IBD and MS. “The gut plays a large role in the nervous system and the immune system, but we are not totally certain how that directly interacts with MS,” says Barry. The onset of MS has been linked to changes in the gut microbiome, and as mentioned previously, IBD can be a risk factor for neurological complications in rare cases. Both conditions have been linked to damage to myelin, and the findings of one study suggest that disruptions in the gut microbiota can lead to chronically dysregulated myelination. e60dc2a1-f33c-4a05-9b50-8e3e8e597629046054aa-a7ad-4f51-b4af-1dff9782f5ef “Research has shown that the immune system is shaped by events in the gut and that immune cells in the gut can actually travel all the way to the central nervous system,” notes Carlos Camara-Lemarroy, MD , assistant professor at the University of Calgary’s Hotchkiss Brain Institute in Canada. “This is why the gut-brain axis may be important for development of MS and other inflammatory conditions.” Whatever the exact nature of the connection between IBD and MS, there seems to be an elevated risk in people with one of the conditions to have the other as well. The reason that’s important, Barry adds, is that anti-TNF therapy, also known as biologics — one of the most common classes of medication that’s prescribed for IBD — is associated with the potential worsening of MS, as well as other demyelinating neurological conditions like transverse myelitis and optic neuritis. “It’s not entirely clear, but that’s definitely a conversation that I as a neurologist would want to have with a patient’s gastroenterologist,” he says. On the other hand, there are also classes of drugs that are effective in both IBD and MS. “For example, there’s a drug called natalizumab that’s approved for both MS and CD, and a newer drug called ozanimod that’s approved for MS and UC,” Melmed says. “So in instances where the two conditions overlap, those might be drugs to consider.” “There would be an opportunity there to potentially treat the patient with one of these medications, as long as the gastroenterologist is in agreement as well,” adds Barry. Melmed is quick to add that people who have IBD or MS shouldn’t necessarily rush to be tested for the other condition unless their symptoms clearly indicate that they might have both. “It’s not an easy, clear-cut diagnosis in someone who isn’t symptomatic, so it isn’t feasible to do MRI scans for MS in everyone with IBD.” However, given the increased prevalence of MS in people who have IBD, Barry recommends that people with IBD get a referral to a neurologist if they experience weakness, tingling or numbness, or trouble walking.
Risk Factors and Prevention Risk Factors MS and IBD share several common risk factors:e60dc2a1-f33c-4a05-9b50-8e3e8e5976291a7a338e-eb68-408e-bc95-bb68fd0752a7 Smoking Higher socioeconomic status Vitamin D deficiency Cold climate Other common risk factors include: Race and ethnicity, with white people generally being at higher risk of both MSe60dc2a1-f33c-4a05-9b50-8e3e8e597629821c0eb4-ca2b-4a56-a103-3e12837ab989 and IBDe60dc2a1-f33c-4a05-9b50-8e3e8e59762972c6c200-5044-4fc6-becc-87fdc771dc82 Age, with IBD most often developing before age 30e60dc2a1-f33c-4a05-9b50-8e3e8e59762972c6c200-5044-4fc6-becc-87fdc771dc82, and the onset of MS most often occurring between age 20 and 40e60dc2a1-f33c-4a05-9b50-8e3e8e597629821c0eb4-ca2b-4a56-a103-3e12837ab989 Family history is a risk factor in both MSe60dc2a1-f33c-4a05-9b50-8e3e8e597629821c0eb4-ca2b-4a56-a103-3e12837ab989 and IBDe60dc2a1-f33c-4a05-9b50-8e3e8e59762972c6c200-5044-4fc6-becc-87fdc771dc82 Certain viral infections, including Epstein-Barr — which causes infectious mononucleosis, more commonly known as mono — are linked to MS. Women are at a higher risk of developing MS, as well. A link between obesity and MS has also been found in women. e60dc2a1-f33c-4a05-9b50-8e3e8e597629821c0eb4-ca2b-4a56-a103-3e12837ab989 Meanwhile, the use of nonsteroidal anti-inflammatory drugs has been linked to the development of IBD.e60dc2a1-f33c-4a05-9b50-8e3e8e59762972c6c200-5044-4fc6-becc-87fdc771dc82
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