Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm

Yeseong Kim; Fahmi Shibli; Yuhan Fu; Gengqing Song; Ronnie Fass

doi:10.5056/jnm22173

J Neurogastroenterol Motil https://doi.org/10.5056/jnm22173

Multiple Sclerosis Is Associated With Achalasia and Diffuse Esophageal Spasm

Yeseong Kim

,¹ Fahmi Shibli,² Yuhan Fu,¹ Gengqing Song,² and Ronnie Fass

¹Department of Internal Medicine, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA; and ²The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA

Correspondence to: Ronnie Fass, MD, MACG
The Esophageal and Swallowing Center, Division of Gastroenterology and Hepatology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
Tel: +1-216-778-3145, Fax: +1-216-778-2074, E-mail: rfass@metrohealth.org

Received: October 10, 2022; Revised: April 12, 2023; Accepted: April 12, 2023; Published online: August 2, 2023

Abstract: Background/Aims
Multiple sclerosis (MS) is an inflammatory disease characterized by the demyelination of primarily the central nervous system. Diffuse esophageal spasm (DES) and achalasia are both disorders of esophageal peristalsis which cause clinical symptoms of dysphagia. Mechanisms involving dysfunction of the pre- and post-ganglionic nerve fibers of the myenteric plexus have been proposed. We sought to determine whether MS confers an increased risk of developing achalasia or DES.
Methods
Cohort analysis was done using the Explorys database. Univariate logistic regression was performed to determine the odds MS confers to each motility disorder studied. Comparison of proportions of dysautonomia comorbidities was performed among the cohorts. Patients with a prior diagnosis of diabetes mellitus, chronic Chagas’ disease, opioid use, or CREST syndrome were excluded from the study.
Results
Odds of MS patients developing achalasia or DES were (OR, 2.09; 95% CI, 1.73-2.52; P < 0.001) and (OR, 3.15; 95% CI, 2.89-3.42; P < 0.001), respectively. In the MS/achalasia cohort, 27.27%, 18.18%, 9.09%, and 45.45% patients had urinary incontinence, gastroparesis, impotence, and insomnia, respectively. In the MS/DES cohort, 35.19%, 11.11%, 3.70%, and 55.56% had these symptoms. In MS patients without motility disorders, 12.64%, 0.79%, 2.21%, and 21.85% had these symptoms.
Conclusions
Patients with MS have higher odds of developing achalasia or DES compared to patients without MS. MS patients with achalasia or DES have higher rates of dysautonomia comorbidities. This suggests that these patients have a more severe disease phenotype in regards to the extent of neuronal degradation and demyelination causing the autonomic dysfunction.; Keywords: Achalasia; Database analysis; Diffuse esophageal spasm; Esophageal dysphagia; Multiple sclerosis