Inflammatory Bowel Diseases and Multiple Sclerosis

gç¾ú
GýíBoüùBÿ AèPùBGþ oôkû ìþ|OõAðñl GB uñloï|øBÿ οHþ ìhPé×þ øípAøþ kAyPú GByñl. AgýpA« ko ìÇBèÏBOþ Gpôq øírìBó GýíBoüùBÿ AèPùBGþ oôkû ô
|âõAo}, 3831|; uBë ðùî:| 09|-881
øírìBðþ GýíBoüùBÿ AèPùBGþ oôkû ô GýíBoÿ ìõèPýLê Außépôq:
ìÏpÖþ kô GýíBo
kÞPp ðB¾p AGpAøýíþ koüBðþ1* , kÞPp ìpüî OBWýà 2 , kÞPpìdíl GzByPþ 2 , kÞPp GBGà cÜ KñBû 2
1 AuPBk, Gh{ âõAo}, GýíBouPBó AìBï gíýñþ, kAðzãBû Îéõï Kryßþ OùpAó
2
Ktôøzãp, GýíBouPBó AìBï gíýñþ, kAðzãBû Îéõï Kryßþ OùpAó
ìõèPýLê Außépôq ko OÏlAkÿ Aq GýíBoAó ârAo} ylû AuQ. Gpôq ÎçDî ô ðzBðú|øBÿ üßþ Aq Aüò k ô GýíBoÿ ko GýíBoAó ìHPç Gú GýíBoÿ küãp GBül Âíò
GpAðãýhPò yà GBèýñþ ìPh¿¿ýò, ko ¾õoR èrôï GB AðXBï AÚlAìBR Ozhý¿þ ðýr øípAû GByl.
ko Aüò ârAo}, Gú ìÏpÖþ k ô GýíBo ìHPç Gú GýíBoüùBÿ AèPùBGþ oôkû, Þú Gú|Æõo øírìBó Gú GýíBoÿ ìõèPýLê Außépôq ðýr ìHPç Gõkðl, KpkAgPú ylû
AuQ. âõAo}, 3831; uBë ðùî: 09-881
ôAsû|øBÿ Þéýlÿ: GýíBoüùBÿ AèPùBGþ oôkû, ÞõèýQ qgíþ, ìõèPýLê Außépôq
ÞBø{ GýñBüþ ðlAyPú AuQ. GýíBo WùQ AoqüBGþ GýzPp ko GýíBouPBó
GvPpÿ |yl. ko Aï|@o|@ÿ AðXBï ylû, KçÞùBÿ ìPÏlkÿ ko ìBkû u×ýl
ìÛlìú
GýíBoüùBÿ AèPùBGþ oôkû GB ^ñlüò uñloï οHþ øípAøþ kAoðl Þú
ðõAcþ ìXBôo GÇñþ ô uíþ|AôôAë uñPpôï ô Wõk kAyQ (yßê 1). ko
ìBüÐ ìÓrÿ- ðhBÎþ yBgÀ |GgI |GýzPp Aq 7/0 Gõk, ôèþ AèýãõÞéõ ðBë
Aq Wíéú @ðùB GýíBoÿ ìõèPýLê Außépôq AuQ. ko^ñlüò ìÇBèÏú ðzBó
kAkû ylû AuQ Þú ìýrAó Gpôq GýíBoÿ ìõèPýLê Außépôq ko GýíBoAó
GBðl AÖrAü{ ðlAyQ. GýíBo GB OzhýÀ ìõèPýLê Außépôq
|)sisorelcs elpitlum etinifed yllacinilc( |OdQ koìBó GB KBèw
ìHPç Gú GýíBoüùBÿ AèPùBGþ oôkû GýzPp Aq WíÏýQ WBìÏú AuQ(7-1) .
koÆþ kû uBë, Aq ìýBó 264 GýíBo ìHPç Gú GýíBoüùBÿ AèPùBGþ oôkû
ÞõoOýßõuPpôDýl Gú ìlR üà ø×Pú ÚpAo âpÖQ ô GÏl Aq @ó GpAÿ GýíBo
Kpkðýrôèõó gõoAÞþ (06 ìýéþ|âpï oôqAðú) @ÒBq yl. Kpkðýrôèõó Gú
(604 |ìõok ÞõèýQ qgíþ ô 65 ìõok Þpôó) ìpAWÏú|Þññlû Gú koìBðãBû
ìB, 2 GýíBo Gú|Æõo øírìBó GýíBoÿ ìõèPýLê Außépôq ðýr kAyPñl. ko
Aüò ârAo} Gú ìÏpÖþ Aüò k ô GýíBo KpkAgPú gõAøl yl.
ìÏpÖþ GýíBoAó
GýíBo Aôë @ÚBÿ 42 uBèú, Aøê OùpAó ô kAðzXõ AuQ Þú ÎçDî ôÿ
kouBë 8731 Gú|¾õoR Îlï øíBøñãþ ÎÃçR kooAû oÖPò (@OBÞvþ)
@ÒBq yl. GýíBo yp f cBèþ Aq ÞpgPþ ô Gþ|cvþ AðlAìùB, k ô Gýñþ ô
*
ðõüvñlû ìvEõë: kÞPp ðB¾p AGpAøýíþ koüBðþ- OùpAó, GéõAo ÞzBôoq,
GýíBouPBó AìBï gíýñþ, Gh{ âõAo}
E-mail: nebrahim@sina.tums.ac.ir
Oé×ò: 6 4 4 9 9 78 8 | ðíBGp: 0 48 9 9 78 8 yßê 1|: Aï|@o|@ÿ ìÓr GýíBo Aôë Þú ko@ó KçÞùBÿ ìPÏlk ko ìBkû u×ýl ðõAcþ
ìXBôo GÇñþ ô uíþ|AôôAë uñPpôï ìzBølû ìþ|yõk.
âõAo} / uBë ðùî / yíBoû 3 / KBüýr 3831
188

ìÇp f Þññlû ÞõèýQ qgíþ Gõk. GpAÿ GýíBo Kpkðýrôèõó gõoAÞþ 04
ìýéþ|âpï oôqAðú ô uõè×BuBæqüò gõoAÞþ 0003 ìýéþ|âpï oôqAðú OXõür
Þõèõ ðõußõKþ AðXBï ylû AèPùBJ ko upAup Þõèõó (KBó|ÞõèýQ)
øípAû GB qgíùBÿ uÇdþ ìPÏlk ô Wõk kAyQ. WõAJ GýõKvþ
ìBû AkAìú KýlA Þpk. ko @qìBü{ ìlÖõÑ gõó ìh×þ ìzBølû âpkül.
ðPBüY âBuPpôußõKþ ô OpAðrüQ oôkû GBoüà ÆHýÏþ Gõk; ôèþ ko
ÎpÅ üà ìBû ÚÇÐ yl. üà ìBû GÏl ôÿ k^Bo AuùBë (3-2 GBo ko oôq)
yl. GýíBo kÖÐ GéÓî, kë|k|ok ô AuùBë yHBðú ðlAyQ. ÎçDî clôk uú
koìBó GB KBèw ÞõoOýßõuPpôDýl Gú ìlR üà ø×Pú ô uLw ÚpÁ
Kpkðýrôèõó 04 ìýéþ|âpï oôqAðú ÚpAo âpÖQ. Kpkðýrôèõó Gú|OloüY ô ko
ìþ|kAk. ènA GýíBo GB OzhýÀ ìõèPýLê Außépôq |
)sisorelcs elpitlum etinifed detroppus yrotarobal( |OdQ
AôèýãõÞéõ ðBë GBðl |1
)BCO( |ìBüÐ ðhBÑ GýíBo ðýr AÖrAü{ ðzBó
AuQ. koAï|@o|@ÿ AðXBï ylû KçÞùBÿ ìPÏlk koìBkû u×ýl ðõAcþ ìXBôo
GÇñþ ô AKPýà ÞýBuíB oôüQ yl )IRM evitisop ecaps(|. øí`ñýò
GýíBok ôï gBðíþ AuQ 32 uBèú, Aøê OùpAó ô kAðzXõÞú kouBë 1831
Gú kðHBë ÞBø{ GýñBüþ GpAÿ ôÿ OzhýÀ ðõoüQ AKPýà ìÇp f ylû
ÚpÁ @uBÞõë 0042 ìýéþ|âpï ko oôq ko ìpcéú gBìõyþ |
)noissimer( |AuQ.
@ÒBq yl. Kpkðýrôèõó Gú|OloüY ô ko ÎpÅ uú ìBû ÚÇÐ yl. ko cBë
cBÂp, Kw Aq ânyQ üà uBë Aq OzhýÀ GýíBoÿ Þpôó GB ì¿pÙ
)sitiloc s'nhorc( |Gõk. GB øíýò OzhýÀ koìBó gõoAÞþ GB
Kpkðýrôèõó 01 ìýéþ|âpï oôqAðú ô ÚpÁ @uBÞõë 0042 ìýéþ|âpï ko oôq
^zî ìþ|gõok Þú ko ÖõA¾ê @ðùB ìhBÉ uBèî )aera piks( ôWõk
kAyQ||. WõAJ GýõKvþ ìÇp f Þññlû ÞõèýQ Þpô ðþ |
k ôoìÛÏlÿ ô oÞPõï ÆHýÏþ Gõk; ôèþ koðBcýú uýãíõ Dýl AèPùBJ ylül
ô qgíùBÿ ìPÏlk ô Wõk kAyQ. ÂBüÏBR ìzBGùþ ko upAup Þõèõó Gú
ôqó Gú ìýrAó 8 Þýéõâpï yl. WùQ Gpouþ GýzPp GpAÿ GýíBo
Þõèõ ðõußõKþ AðXBï yl. ko Þõèõ ðõußõKþ AðXBï ylû ðõAcþ
oôqAðú) ÚpAo âpÖQ. Îç|Dî GýíBo GùHõk ðvHþ KýlA Þpk; ôèþ GB ylOþ
ÞíPp OB KñY ìBû AkAìú üBÖQ ô GýíBo ko ÎpÅ Aüò ìlR, k^Bo ÞBø{
gõ ðþ (01-8 GBo kÖÐ ìlÖõÑ ko oôq) ô qôoKýa âpkül ô GB OzhýÀ
uBèíõ ðéõq OdQ koìBó GB ÚpÁ uýLpô ÖéõÞvBuýò (0001 ìýéþ|âpï
ìpcéú GýíBo OdQ koìBó GB AüñPpÖpôó |)xenovA( |ÚpAo âpÖQ. ^ùBo
uBë GÏl Aq OzhýÀ ìõèPýLê Außépôq, ôÿ k^Bo kë|kok, AuùBë
OloüY ko ÎpÅ üà ìBû ô ðýî ÚÇÐ âpkül ô ÎçDî GýíBo GùHõk üBÖQ.
GýíBo ko Æþ k ô uBë GÏl, 2 GBo küãp k^Bo cíéú @OBÞvþ yl. ko Aüò
GýíBoüùBÿ AèPùBGþ oôkû ô ìõèPýLê Außépôq
âõAo} / uBë ðùî / yíBoû 3 / KBüýr 3831
ìÇBèÏBR Gú Îíê @ìlû ðzBó kAkû|Aðl Þú uýp GýíBoÿ ìõèPýLê
ÎçDî GýíBoüùBÿ AèPùBGþ oôkû @ÒBq ylû Gõk Þú GB üBÖPú|øBÿ ìõWõk ko
ìÇBèÏBR ÚHéþ øíhõAðþ kAyQ(5-3) .
kAkû ylû Gõk(5-3)
AyBoû Þpk(8)
. ko GýíBoAó ìB ðýr ÎçDî ìõèPýLê Außépôq ÚHê Aq
KpkAgPú|Aðl. AÞTp Aüò GýíBoAó (3 GýíBo) gBðíùBüþ Gõkðl Þú GýíBoÿ
ìõèPýLê Außépôq@ðùB 8-5 uBë ÚHê Aq ypôÑ GýíBoÿ Þpôó OzhýÀ
Gp AuBx WvQ|ô|Wõÿ ìÛBæR, ^ùBo ârAo} küãp Gú ìÏpÖþ 4
GýíBo Þú øírìBó GýíBoüùBÿ AèPùBGþ oôkû ô ìõèPýLê Außépôq kAyPñl
ôèþ Aüò ìÛlAo ðíþ|OõAðl GýBðãp yýõÑ ôAÚÏþ ìõèPýLê Außépôq ko
ìHPçüBó Gú GýíBoüùBÿ AèPùBGþ oôkû|Aÿ ko WBìÏú ìB GByl.
oôkû Þú ko koìBðãBû ìB ko Æõë kû uBë OdQ Kýãýpÿ ô koìBó ÚpAo
âpÖPñl, ÖpAôAðþ ìõèPýLê Außépôq clôk 4/0 ko¾l Gú kuQ @ìl.
oôkû oA yBìê ìþ|ylðl(2) . |ko ìýBó ìHPçüBó Gú GýíBoüùBÿ AèPùBGþ
AèPùBGþ
GýíBoüùBÿ Gú ìHPç GýíBoAó ko¾l 8/0 Þú kAyPñl ðýr Außépôq
küãpÿ Aq @ìpüßB Aq Gýò 474 GýíBo ìHPç Gú GýíBoüùBÿ AèPùBGþ oôkû
ìpAWÏú |Þññlû Gú üà koìBðãBû, ^ùBo GýíBo Gú|Æõo øírìBó ìõèPýLê
(000001/5) O×BôR ÚBGê ìçcËú|Aÿ kAyPú AuQ(1)
uBèýBðú ìõèPýLê Außépôq ko GýíBoAó ìHPç Gú GýíBoüùBÿ AèPùBGþ oôkû
GpAGp GB 000001/81 Gp@ôok ylû Þú ðvHQ Gú WíÏýQ ÎBkÿ AðãévPBó
ko ìõok Gpôq øírìBó GýíBoüùBÿ AèPùBGþ oôkû ô ìõèPýLê Außépôq
@ìBo kÚýÛþ ko kuQ ðývQ. Gp AuBx ìÇBèÏú|Aÿ ko AðãévPBó Gpôq
øípAû Gõkó GýíBoüùBÿ AèPùBGþ oôkû GB ìõèPýLê Außépôq AyBoû ylû
AuQ|(5-1ô 9) .
. øí`ñýò ârAoyùBÿ ìPÏlkÿ ô Wõk kAoðl Þú ko@ðùB Gú
ylû|Aðl. Aq Wíéú Aüò OËBøpAR ìþ|OõAó Gú cõAkV ÎpôÚþ ìÓr,
ìýéõKBOþ|øB, ðõoôKBOþ|øBÿ ìdýÇþ, ìýõKBOþ|øB ô ìýBuPñþ âpAôüw
GdU
OËBøpAR οHþ ìPÏlkÿ ko AoOHBÉ GB GýíBoüùBÿ AèPùBGþ oôkû mÞp
ô Aüò GýíBoÿ ðýr ko ìpcéú gBìõyþ AuQ.
. Gp AuBx @ìBo
ko ìpcéú gBìõyþ AuQ. øî|AÞñõó koìBó ìõèPýLê Außépôq GB
AüñPpÖpôó (|fibeR|, üà |oôq koìýBó ô Gú ¾õoR qüpWélÿ) AkAìú kAok
oôqAðú ô @qAOýõKpüò 001 ìýéþ|âpï oôqAðú AkAìú üBÖQ. ko cBë cBÂp,
Kw Aq ânyQ clôk k ô uBë Aq ypôÑ ÎçDî ÞõèýQ qgíþ, GýíBoÿ
yl. GÏl Aq clôk uú ìBû, ÎçDî GýíBo GùHõk ÚBGê OõWùþ KýlA Þpk ô
koìBó ðãùlAoðlû Gú|¾õoR uõè×BuBæqüò gõoAÞþ 0003 ìýéþ|âpï
1. oligoclonal banding
189

ìpAWÐ
âõAo} / uBë ðùî / yíBoû 3 / KBüýr 3831
Aq@ðñl Þú AuP×Bkû Aq kAoôøBÿ Âl ||a|-FNT |(ìBðñl |bamixilfni|) ko
OõWýú oôAGÈ ìõWõk ko kuQ ðývQ(11 ,01). |Aq ÆpÖþ ârAoyùB cBÞþ
WùQ
ÞBÖþ AÆçÎBR AìB Þpk. AyBoû gõkAüíñþ AgPçæR GB @ðùB
Aüò k ô GýíBoÿ, Aq ðËp ÎõAìê qìýñú|Aÿ, kAoAÿ ô Wõû ìzPpÞþ
ìþ|GByñl Þú Aq Wíéú @ðùB ìþ|OõAó Gú OõqüÐ ðtAkÿ, uñþ ô øípAøþ
GýíBoAó ìB uBGÛú gBðõAkâþ ìõèPýLê Außépôq ô GýíBoüùBÿ AèPùBGþ
oôkû oA mÞp ðíþ|Þpkðl.
AuPÏlAk Gú GýíBoÿ ìõèPýLê Außépôq ðÛzþ ðlAoðl(7) . øýa|üà Aq
AÖrAü{
|ko |)2DON( Þpôó GýíBoÿ ko ìvEõë sðùBÿ Þú yl külû
Îéþ|oÒî Aüñßú uBèùB ÚHê, AoOHBÉ gBðõAkâþ Gýò GýíBoüùBÿ
AèPùBGþ oôkû ô ìõèPýLê Außépôq ìõok OõWú ÚpAo âpÖQ(6) , GÏløB
GýíBoüùBÿ AèPùBGþ oôkû ðýr ko øp k ô GýíBo Gú|gõGþ Gú koìBó KBui
kAkðl.
ÖpôÞ{ )gnittimer dna gnispaler( |øípAû Gõk. øýa|ÞlAï Aq
GýíBoAó ðBOõAðBüýùBÿ οHþ øípAû ðlAyPñl. ÎçDî ìpGõÉ Gú
gõGþ kAok(2) . uýp GýíBoÿ ìõèPýLê Außépôq ko øpk ô GýíBo ìB GB Îõk ô
@âùþ
Ký{ oôkû AèPùBGþ GýíBoüùBÿ Gú ìHPç GýíBoAó ko Außépôq
kÞPp AGpAøýíþ koüBðþ ô øíßBoAó
ìPh¿¿ýò ÚpAoâýpk(9,1) .
Außépôq ô øí`ñýò øñãBï Gpôq ÎçDî âõAoyþ-oôkû|Aÿ ìrìò ko
ìHPçüBó Gú ìõèPýLê Außépôq, GpouýùBÿ KBoAÞéýñýßþ ìõok ðËp
GB OõWú Gú ìÇBèI ÖõÝ, Aüò ðßPú cBDr AøíýQ AuQ Þú ko uýp
GBèýñþ GýíBoüùBÿ AèPùBGþ oôkû, ÎçDî οHþ ìÇp f|Þññlû ìõèPýLê
|AuP×Bkû ðíþ|Þpkðl; ÖpÂýú Aôë Þú ko ðùBüQ GýBðãp oAGÇú GýíBoüùBÿ
AèPùBGþ oôkû ô ìõèPýLê AußépôqAuQ GýzPpìþ|OõAðl ìõok OõWú ÚpAoâýpk.
ìvPÛýî ì¿pÙ Aüò kAoôøB kAðvQ. cBë, GB OõWú Gú Aüñßú AÞTpüQ
GýíBoAó ârAo} ylû ko ìÛBæR ìhPéØ Aq kAoôøBÿ Âl |a|-FNT
ìþ|OõAðl Gú ôAuÇú ì¿pÙ kAoôøBüþ øí`õó |bamixilfni |AÖrAü{
üBGl. Gp AuBx ÖpÂýú k ôï ìõèPýLê Außépôq oA ìþ|OõAó ÎBoÂú
Gú Aüò ìvEéú ìþ|OõAó k ô ÖpÂýú ìP×BôR oA ìÇp f Þpk: GpAuBx ÖpÂýú
Aôë Gpôq ìõèPýLê Außépôq ko ìHPçüBó Gú GýíBoüùBÿ AèPùBGþ oôkû
ìõèPýLê Außépôq ðýr kAoðl, Aq Aüò kAoôøB AuP×Bkû ðzõk(31) . GB OõWú
øírìBó
Þú oôkû AèPùBGþ GýíBoüùBÿ Gú ìHPç GýíBoAó ko AuQ ylû
kìýéýñýrAó yHýú Gú ìõèPýLê Außépôq yõk(21) . Gú øíýò kèýê Oõ¾ýú
AèPùBGBR
Gpôq Gú ìñXp ìþ|OõAðl oôkû AèPùBGþ GýíBoüùBÿ Gú ìHPçüBó
1. Rang EH, Brooke BN, Hermon-taylor J. Association of
ulcerative colitis with multiuple sclerosis[letter]. lancet
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2. Keiko K, Hunter SF, Tholander MS et al. Concurrence of
inflammatory bowel disease and multiple sclerosis. Mayo
Clin Proc 2000; 75: 802-6.
3. Kitchin LI, Knobler RL, Friedman LS. Crohn's disease in a
patient with multiple sclerosis. J Clin Gastroenterol 1991;
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4. Bussino GP, Corrente G, visiniti D. Crohn's disease and
multiple sclerosis: a single case report. Ital J Neurol Sci
1994; 15: 303-6.
5. Agranoff D, schon F. Are focal white matter lesions in
patients with inflammatory bowel disease linked to multiple
sclerosis [letter]. Lancet 1995; 346: 190-1.
6. Minuk GY, Lewkonia RM. Possible familial association of
multiple sclerosis and inflammatory bowel disease[letter]. N
Eng J Med 1986; 314: 586.
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NOD2 gene variants are not involved in determining susceptibility
to multiple sclerosis. J Neurol Neurosurg Psychiatry
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8. Lossos A, River Y, Eliamkim A et al. Neurological aspects of
inflammatory bowel disease. Neurology 1995; 45: 416-21.
9. Pandian JD, Pawar G, Singh GS et al. Multiple sclerosis in a
patient with chronic ulcerative colitis. Neurol India 2004;
52: 282-283.
10.Thomas CW Jr., Weinshenker BG, Sandborn WJ.
Demyelination during anti-tumor necrosis factor alpha therapy
with infliximab for Crohn's disease. Inflamm Bowel Dis
2004; 10: 28-31.
11.Do Olek MJ. Epidemiology, risk factors, and clinical features
of multiple sclerosis. In: UpToDate, Rose BD,
UpToDate, Wellesley, MA, 2004.
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190

Inflammatory Bowel Diseases and Multiple Sclerosis
Ebrahimi Daryani N
Department of
Gastroenterolgoy, Imam
Khomeini Hospital, Tehran
University of Medical Sciences
Tajik M
Department of
Gastroenterolgoy, Imam
Khomeini Hospital, Tehran
University of Medical Sciences
Bashashati M
Department of
Gastroenterolgoy, Imam
Khomeini Hospital, Tehran
University of Medical Sciences
Haghpanah B
Department of
Gastroenterolgoy, Imam
Khomeini Hospital, Tehran
University of Medical Sciences
ABSTRACT
Inflammatory Bowel Diseases and
Multiple Sclerosis:
A Look on Two Cases
The Inflammatory bowel diseases (IBD) have been found to
accompany some neurological syndromes including multiple sclerosis
(MS). Recently, Several studies have reported and discussed the
simultaneous presence of IBD and MS in some patients. Thus, in patients
with either disease, the presence of signs and symptoms of the other
should raise the clinical suspicion of the clinician and warrant special
considerations.
In this report, we introduce two IBD patients who have concomitant
involvement of MS. Govaresh 2004; 9: 188-90
Keywords: Inflammatory bowel diseases, Ulcerative colitis, Multiple
sclerosis
Corresponding Author:
Nasser Ebrahimi Daryani MD,
Department of Gastroenterology,
Imam Khomeini Hospital,
Keshavarz Blvd, Tehran, Iran.
Tel: +98 21 88799446
Fax: +98 21 88799840
E-mail:
nebrahim@sina.tums.ac.ir
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