Dr. Armin Alaedini, professor of medicine at Columbia University, studies post-infection chronic conditions and illnesses, specializing in how diseases affect the gastrointestinal system. People with ME/CFS often have severe gastrointestinal problems, including bloating, bowel problems, loss of appetite, nausea, and stomach pain. Many people with ME/CFS also have irritable bowel syndrome. Despite this, gastrointestinal symptoms of ME/CFS remain less well studied than hallmark symptoms, like fatigue or cognitive dysfunction. Gastrointestinal symptoms are often considered peripheral, and neither the Institute of Medicine nor the Canadian Consensus Criteria includes gastrointestinal symptoms in their defining frameworks for ME/CFS.
To address this gap, the researchers evaluated the presence of gastrointestinal symptoms in people with ME/CFS and examined how these symptoms relate to ~50 other disease symptoms. They also assessed how gastrointestinal symptoms associated with ME/CFS-related immunological dysfunction by measuring biomarkers for systemic inflammation (plasma C-reactive protein) and gut-related inflammation (antibodies against foods or gut microbes).
People with ME/CFS (n = 116) reported significantly more frequent and severe gastrointestinal symptoms than healthy people (n = 80). Over half of the people with ME/CFS had been diagnosed with irritable bowel syndrome, while less than one in ten healthy people had this diagnosis. Gastrointestinal symptoms significantly correlated with core ME/CFS symptoms, like cardiovascular symptoms, fatigue (both mental and physical), flu-like symptoms, neurological issues, pain, sensory sensitivity, and sleep issues. Moreover, as observed for these other symptoms, greater severity of gastrointestinal symptoms was associated with greater systemic inflammation.
These results suggest that gastrointestinal symptoms are a common and clinically important feature of ME/CFS and may even represent a core component of the disease. Treatments targeting the gut, like celiac plexus block, fecal microbial transplantation, probiotics, or special diets, may help subgroups of people with ME/CFS with especially severe gastrointestinal involvement. However, clinical research on these types of treatments is at early stages, and more work is needed to understand the efficacy and safety of these approaches.
The research team noted some limitations to their study. Future studies should involve larger, more diverse cohorts to confirm these findings. They should use objective measures of gastrointestinal dysfunction beyond the self-reported questionaries used here, and should expand the panel of biomarkers used to assess gastrointestinal dysfunction. Also, they should more carefully consider potentially confounding factors, like medications, diets, or supplements that could affect the gastrointestinal tract, thereby improving interpretability of results.
Why This Study Matters:
- 🧠 Guides future clinical trials: Emphasizes the need for upcoming clinical trials, including NIH RECOVER–led studies, to evaluate interventions that specifically target gastrointestinal symptoms of infection-associated chronic conditions.
- 🧪 Lays the Groundwork for Preventative Treatments: Suggests that treatments targeting the gastrointestinal tract, like celiac plexus block, fecal microbial transplantation, probiotics, and special diets, may substantially help many people with ME/CFS.
- 🧘 Validates Overlooked Symptoms of ME/CFS: Highlights the widespread presence of gastrointestinal symptoms among people with ME/CFS, which have historically received less attention than other manifestations of the disease.
Solve M.E. funded and helped recruit participants for this study, which appeared in the Journal of Translational Medicine.
Dr. Alaedini told us, “Support from Solve M.E. helped us pursue important questions about the role of the gut and immune system in ME/CFS. In this study, we found that gastrointestinal symptoms are not only highly prevalent but are closely linked to the broader clinical phenotype and to objective inflammatory and immune abnormalities. These findings help advance our understanding of the biological heterogeneity of ME/CFS and may contribute to identifying patient subgroups that could benefit from more targeted therapeutic approaches. I’m deeply grateful to Solve M.E. and its donors for their support of this research and for their commitment to advancing ME/CFS science in ways that bring us closer to more effective treatments.”