Is There a Link Between IBD and MS?
By By Ajai Raj. Medically Reviewed by Jason Paul Chua, MD, PhD,
13 days ago
Key Takeaways
- Inflammatory bowel disease (IBD) and multiple sclerosis (MS) are both thought of as immune-mediated, inflammatory diseases, and both have been linked to the gut.
- People who have IBD are at greater risk of having MS and vice versa, but it's relatively rare to have both.
- Some IBD treatments can worsen MS; medications can effectively treat both conditions.
Prevalence of MS and IBD
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."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?
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.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?
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.IBD and MS: Some Overlapping 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. 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. 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.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. 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?
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.
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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."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
MS and IBD share several common risk factors:- 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 MS and IBD
- Age, with IBD most often developing before age 30 , and the onset of MS most often occurring between age 20 and 40
- Family history is a risk factor in both MS and IBD
Editorial Sources and Fact-Checking
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy . We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Sources
- Kadowaki A et al. The Gut-CNS Axis in Multiple Sclerosis. Trends in Neurosciences . August 2020.
- Alkhawajah M et al. Multiple Sclerosis and Inflammatory Bowel Diseases: What We Know and What We Would Need to Know! Multiple Sclerosis Journal . October 2012.
- Wang X et al. Multiple Sclerosis and Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis. Annals of Clinical and Translational Neurology . February 2022.
- Inflammatory Bowel Disease (Overview). Cleveland Clinic. May 3, 2021.
- Symptoms & Causes of Multiple Sclerosis. Mayo Clinic. December 24, 2022.
- Bourre B et al. Multiple Sclerosis and Bowel Symptoms: Frequency and Barriers to Their Management. Multiple Sclerosis and Related Disorders . October 2023.
- Bowel. MS Society UK.
- Morís G. Inflammatory Bowel Disease: An Increased Risk Factor for Neurologic Complications. World Journal of Gastroenterology . February 2014.
- Yang Y et al. Acute Transverse Myelitis in an Adult-Patient With Underlying Ulcerative Colitis: A Case Report. BMC Gastroenterology . April 2022.
- Transverse Myelitis. National Institute of Neurological Disorders and Stroke. February 22, 2024.
- Keogh C et al. Myelin as a Regulator of Development of the Microbiota-Gut-Brain Axis. Brain, Behavior, and Immunity . January 2021.
- Inflammatory Bowel Disease (IBD). Mayo Clinic. September 3, 2022.
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