From the Guidelines
Parkinson's disease commonly causes various gastrointestinal manifestations throughout the digestive tract, including dysphagia, delayed gastric emptying, constipation, and defecatory dysfunction, with constipation being particularly prevalent, affecting up to 80% of patients. These symptoms occur because Parkinson's affects not only the central nervous system but also the enteric nervous system, with alpha-synuclein deposits found throughout the gut, leading to autonomic dysfunction that disrupts normal gastrointestinal motility and function 1.
Gastrointestinal Manifestations
- Dysphagia (difficulty swallowing)
- Delayed gastric emptying
- Constipation
- Defecatory dysfunction
- Gastroesophageal reflux disease (GERD)
- Reduced saliva production leading to dry mouth
- Excessive drooling (sialorrhea) due to impaired swallowing
Treatment and Management
Treatment typically involves dietary modifications, such as increased fiber and fluids, regular exercise, and medications like polyethylene glycol or lubiprostone for constipation 1.
- Dietary modifications: increased fiber and fluids
- Regular exercise
- Medications: polyethylene glycol or lubiprostone for constipation
- Prokinetic agents: domperidone (10mg three times daily) for gastroparesis
- Anticholinergic medications: glycopyrrolate (1-2mg twice daily) for sialorrhea The use of fermented milk containing probiotics and prebiotic fiber can benefit patients with constipation, as it has been shown to increase the number of complete bowel movements and improve stool consistency 1. Management of these symptoms is crucial as they significantly impact quality of life and medication absorption in Parkinson's patients 1.
From the Research
Gastrointestinal Manifestations of Parkinson's Disease
The gastrointestinal manifestations of Parkinson's disease (PD) are numerous and can significantly impact the quality of life of patients. Some of the common gastrointestinal symptoms experienced by patients with PD include:
- Dysphagia (difficulty swallowing) 2, 3, 4
- Constipation 2, 5, 3, 6, 4
- Nausea 2
- Bloating 2
- Gastroparesis (delayed gastric emptying) 3, 6, 4
- Gastroesophageal reflux 4
- Small intestinal bacterial overgrowth syndrome (SIBO) 6
- Intestinal methanogen overgrowth 4
- Esophageal dysmotility 4
- Oropharyngeal dysphagia 4
- Dyssynergic defecation 4
Pathophysiology and Treatment
The pathophysiology of gastrointestinal symptoms in PD is complex and involves the enteric nervous system. Treatment of these symptoms can be challenging, but various options are available, including:
- Medications such as polyethylene glycol, lubiprostone, and levodopa 5, 6
- Prokinetics and laxatives 6
- Motilin agonists, dopamine receptor antagonists, Ghrelin agonists, muscarinic agonists, and 5-HT4 receptor agonists 6
- Antibiotics and probiotics for SIBO 6
- Biofeedback therapy and functional magnetic stimulation for constipation 5
- Integrated care models such as the Parkinson's Research and Integrated Support Model (PRISM) 4
Impact on Quality of Life
Gastrointestinal symptoms can significantly impact the quality of life of patients with PD, affecting their daily activities, productivity, and overall well-being 5, 3, 4. Effective management of these symptoms is essential to improve patient outcomes and quality of life. Studies have shown that treatment of gastrointestinal symptoms can lead to significant improvements in symptom severity and quality of life 4.