The aim in this study is to understand the frequency of gastrointestinal symptoms in persons with ALS and relationship to disease duration and severity.

Amyotrophic Lateral Sclerosis is a disorder of motor neurons in which involvement of the enteric nervous system (ENS) has been implicated. Delayed gastric emptying and slowing of colonic transit time are reported. These symptoms impact the use of anticholinergic agents for treatments and offer opportunities for interventions that improve quality of life.

Patients diagnosed with ALS were recruited from the MDA/ALS Center of Hope Clinic at Temple University and healthy control volunteers were accepted. Patient Assessment of GI symptoms (GI-SYM) and Patient Assessment of Constipation (PAC-SYM) questionnaires are patient reported severity of symptoms over a 2-week history on an ordinal level. ALS Functional Rating Scale – Revised (ALSFRS-R), a 12-item questionnaire, assesses functional disability across 4 domains: bulbar, fine motor, gross motor and respiratory. Data was analyzed using IBM SPSS Statistics software.

31 subjects are enrolled in the study with 12 controls and 19 ALS cases. The median(IQR) GI-SYM, PAC-SYM, and ALSFRS-R scores were 4.5(8), 1(4.75), and 42.5(15), respectively.  A two-tailed t test, assuming unequal variances, revealed significant differences in PAC-SYM scores between healthy controls and ALS cases (t(23.22) = -2.17, p = 0.041). Spearman Rank Correlation revealed positive correlation between GI-SYM and PAC-SYM (r(26) = 0.70, p < 0.001) and negative correlation between ALSFRS-R and GI-SYM (r(26) = -0.44, p = 0.019).

In this preliminary study, the 2-week history GI-SYM questionnaire negatively correlated with ALSFRS-R scores and there was significant difference in PAC-SYM scores between healthy controls and ALS cases, suggesting potential enteric nervous system involvement. Recent evidence of brain-gut interaction, importance of the ENS, and the role of the microbiome in ALS and other neurodegenerative diseases suggests these symptoms are in part disease related.