Inflammatory bowel disease (IBD) has been linked to an increased risk for subsequent neurological disorders, new research suggests.
Initial 2-year results from an ongoing study that will be presented May 1 at the American Academy of Neurology’s 59th Annual Meeting, in Boston, Massachusetts, showed individuals with IBD were 4 times more likely to develop neuromuscular conditions (including carpal tunnel syndrome and small fiber neuropathy) and 6 times more likely to have sensorimotor polyneuropathy (PN) compared with individuals with other types of gastric conditions.
“Based on these initial results, we believe IBD itself is directly related to the neuropathy and that neuropathy in these patients is much more common than we previously thought,” the study’s principal investigator, Francisco De Assis Gondim, MD, PhD, from the Federal University in Ceara, Brazil, told Medscape.
Women at Greater Risk for Neuromuscular Complications
Although the link between IBD and neurologic disease has been reported before, most of the studies have been small, retrospective case series. In 2005 (Gondim FA et al. Brain. 2005;128:867-879), Dr. Gondim and colleagues also reported the association in a case series of 33 patients with IBD and PN as well as a literature analysis, At the time, this was the largest study and provided the most convincing evidence of the link between IBD and peripheral neuropathy to date.
The initial aim of the current cohort study, said Dr. Gondim, was to determine the prevalence of IBD-associated neurologic disease. To do this, investigators compared 103 individuals with IBD
37 with Crohn’s disease (CD) and 66 with ulcerative colitis (UC)
with 51 control subjects who had other gastric disorders, including dyspepsia, gastritis, and irritable bowel syndrome (IBS).
All subjects received a standard neurological evaluation, including vibration assessment, electromyography, screening for common causes of neuropathy, including possible vitamin B12 deficiency, diabetes, glucose intolerance, and hypothyroidism. They also underwent a neurological workup that included neuroimaging.
Headache was the most commonly reported neurological complaint and had a similar prevalence in all 3 study groups
48.6% in CD patients, 56.9% in the UC group, and 56.9% among controls.
However, the investigators report neuromuscular diseases, including parasthesias and SFN, were much more likely to occur in UC and CD patients compared with the control group.
Carpal tunnel syndrome was 4 times more prevalent in the UC group, and SP was more than 6 times more common in IBD patients, affecting 21% of subjects in the UC and CD groups.
In addition, said Dr. Gondim, the study also showed that neuromuscular complications in general and carpal tunnel syndrome in particular were much more common in women.
A Good Start
“Compared with the control group, the IBD group had a much higher prevalence of neuropathy. In spite of the fact that some of the IBD patients had [neuropathy] risk factors, there were a substantial number who did not, which leads us to conclude there is a direct relationship between IBD and neuropathy,” said Dr. Gondim.
Whether this is due to an immune-mediated phenomenon, an undetected vitamin deficiency, or some other mechanism is not clear, he said. However, the link between IBD and neuropathy is something clinicians need to be aware of, since neuromuscular disease is a common IBD complication that is frequently misdiagnosed as a rheumatological disorder.
The investigators intend to follow study participants for at least another 3 years, with the aim of gaining a better understanding of the natural history of neurological complications in IBD patients.
In the future, Dr. Gondim also hopes to launch a larger, long-term, multicenter cohort study in IBD patients who are neurologically competent at study outset to confirm the link between IBD and neuropathy and better characterize patients who are at risk for neurological complications.
“There’s a lot of work still to do, but this is a good start,” he said.
American Academy of Neurology 59th Annual Meeting: Abstract S16.005. April 28
May 5, 2007
Dr. Perlmutter’s comment:
This is breathtaking that this would be considered breaking news. Please see
BrainRecovery.com which I published 7 years ago. Complementary based physicians have long recognized that inflammation, like that in inflammatory bowel disease, is systemic and therefore affects other organ systems like the nervous system. It’s time for gastroenterologists to talk to neurologists.