Pseudo-obstruction Syndrome in Multiple Sclerosis

Three patients with long-standing multiple sclerosis were found to have clinical features of chronic intestinal pseudo-obstruction consisting of nausea, vomiting, abdominal pain, and distention after meals. Radiographic studies demonstrated dilated loops of bowel without evidence of mechanical obstruction. In addition to standard clinical data, results of jejunal manometry in the patients were compared with those of 10 normal volunteers. Phase III of the migrating motor complex activity fronts occurred in two of the three patients during at least 3 hours of recording. Some contractions exhibited higher than normal amplitudes (>90 mm Hg), but the frequency, mean amplitudes, and motility indices were similar to those recorded in the normal volunteers. After a meal the frequency of contractions was reduced, although the amplitudes were normal to high (>90 mm Hg), and some contractions exhibited a tonic or prolonged component. Postprandial contractions were erratic with periods of intense activity alternating with quiescence. These manometric findings are most compatible with a neuropathic process. When pseudo-obstruction compromised assimilation of orally administered nutrients in these patients, central venous nutrition was required.