Study links constipation with faster ALS progression, poorer survival
Anxiety, depression, sleep problems plague constipated patients
Constipation, a symptom experienced by about half of amyotrophic lateral sclerosis (ALS) patients, is associated with a significantly faster disease progression and poorer survival, according to a new study.
Constipation was also linked to worse anxiety, depression, and sleep problems, data showed.
“Objective assessment of these symptoms is critical for effective disease management,” and “implementing early intestinal management strategies could alleviate constipation symptoms and potentially enhance patients’ quality of life,” the researchers wrote.
The study, “An overlap-weighted analysis on the association of constipation symptoms with disease progression and survival in amyotrophic lateral sclerosis: a nested case-control study,” was published in Therapeutic Advances in Neurological Disorders.
ALS is a neurodegenerative disorder marked by progressive muscle weakness that leads to movement problems and other symptoms such as trouble speaking, swallowing, and breathing. Many people with ALS also experience gastrointestinal problems, which are thought to arise from dysfunction of the nerves and muscles that control the movement of food through the digestive tract.
Commonly overlooked symptom
Constipation, when bowel movements become less frequent and stools become difficult to pass, is a common but overlooked gastrointestinal symptom of ALS. Studies indicate that the incidence of constipation among ALS patients is up to five times higher than in the general population.
Still, “there is no research on the correlation between constipation and disease progression in ALS, which is a matter of significant concern,” the researchers wrote.
A team at the Second Hospital of Hebei Medical University in China conducted a population-based study involving 190 ALS patients to investigate the association between constipation and disease outcomes in ALS.
The group consisted of 121 men and 69 women, 50% of whom had constipation, as assessed by the Knowles-Eccersley-Scott symptom (KESS) questionnaire. It’s estimated that about 14% of people in the general population suffer from constipation.
When patients with and without constipation were compared, those with constipation were significantly older, and had longer disease duration and worse sleep, depression, and anxiety than those without constipation. ALS severity and its progression were also significantly worse among those with constipation, as indicated by scores from the ALS Functional Rating Scale Revised (ALSFRS-R).
The team found that worse constipation scores on the KESS scale significantly correlated with more severe ALS and faster ALS progression, as well as worse scores for sleep, anxiety, and depression.
“These findings suggest that patients with ALS with constipation tend to have lower functional scores and experience more rapid disease progression, compared with patients with ALS without constipation,” the team wrote.
Over nine months of follow-up, 38 patients (25.3%) died, nearly all of whom (92.1%) had constipation. ALS patients with constipation had significantly worse survival rates than those without constipation. Survival was also influenced by the rate of ALS progression (moderate and fast), as well as sleep and depression, results showed.
To evaluate whether constipation is a risk factor for ALS survival, the team applied a nested, case-control study design. Here, the 38 patients who died were compared with 76 who were still alive, matched by age, sex, and body mass index, a measure of body fat. A statistical technique called overlap-weighting was also implemented to dampen the effects of influencing factors.
Results showed that ALS survival was significantly associated with the rate of disease progression (moderate and fast), bulbar onset (early symptoms affecting speech, breathing, and swallowing), and late-stage disease, as indicated by the Milano-Torino (MiToS) system. Constipation was also identified as a relevant risk factor, both before and after overlap-weighting.
A subsequent computer-based bioinformatics analysis suggested that the underlying pathways involved in ALS development and constipation might be similar. One pathway identified was the PPAR signaling pathway, which regulates several important biological functions, including cell metabolism and growth, and inflammatory responses.
“The results confirmed that constipation is one of the risk factors for ALS, along with [the rate of progression], site of onset, and MiToS staging,” the team wrote. “Future studies should include larger and more diverse groups of patients from different institutions to confirm our results and expand on our findings.”
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