Objective:

To determine the prevalence of inflammatory bowel disease (IBD) in patients with multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody disease (MOGAD).

Background:

Studies show an increased prevalence of IBD in MS patients, and of MS in IBD patients. This may be due to shared immunologic and genetic mechanisms in MS and IBD, as well as medications (B-cell depleting therapies for MS may increase the risk of IBD, and anti-TNF-alpha therapies for IBD may also raise the risk of MS). Less is known about the prevalence of IBD in NMOSD and MOGAD.

Design/Methods:

We manually reviewed the charts of all patients with neuroimmunologist-confirmed diagnoses of NMOSD and MOGAD evaluated at our MS Center, as well as 110 consecutively seen MS patients, and extracted relevant medical and treatment history.

Results:

Among 110 consecutively seen MS patients, 3 (2.7%) had confirmed IBD. Among 173 patients with clinician-diagnosed NMOSD and 133 patients with MOGAD, none (0) had IBD. The prevalence of comorbid autoimmune disease was 27% in NMOSD and 5% in MOGAD. The lifetime use of anti-CD20 therapies was 77% in NMOSD and 29% in MOGAD.

Conclusions:

Although patients with NMOSD have an increased risk of autoimmune disease and often receive anti-CD20 therapy (a risk factor for IBD), we did not identify any NMOSD patients with comorbid IBD. Likewise, we did not observe cases of IBD among patients with MOGAD. The prevalence of IBD in our MS patients was higher than would be expected in the general population, consistent with prior reports. Our work suggests that the prevalence of IBD may not be elevated in NMOSD and MOGAD, in contrast to MS. Larger studies are needed to confirm our findings and provide a mechanistic basis of the difference in the prevalence of IBD in NMOSD and MOGAD compared to MS.