Efficacy and safety of probiotics in Parkinson’s constipation: A systematic review and meta-analysis

Abstract

Background: Parkinson’s disease (PD) is the most common neurodegenerative disease closely related to the immune system, among whose prodromes constipation is a representative symptom. Recent Randomized Controlled Trials (RCTs) have proved that probiotics can be used to effectively treat PD constipation, but the results are inconsistent. We performed a meta-analysis to assess the efficacy and safety of probiotic therapy on Parkinson’s constipation.Methods: Questions about the research focus were constructed based on the Participants, Intervention, Comparison and Outcomes (PICO) Criteria. We searched electronic databases such as PubMed, Web of Science, EMBASE, Scopus, EBSCO, Cochrane and Google Scholar until March 2022 for eligible literatures. Our primary endpoints were stool frequency, stool consistency, the number of laxatives uses, UPDRS-III scores and adverse events.Results: 12 eligible studies (n = 818 patients) met the inclusion and endpoint criteria. Meta-analysis results showed that constipation symptoms were improved after probiotic treatment, including an increased stool frequency (WMD = 0.94, 95% CI:0.53 to 1.34; OR = 3.22, 95% CI:1.97–5.29), an improved stool consistency (WMD = 1.46, 95% CI:0.54–2.37), a reduced use of laxatives (WMD = −0.72, 95%CI: −1.04 to−0.41), and also a reduced Parkinson’s UPDRS-III score (WMD = −6.58, 95%CI: −12.02 to −1.14); there was no significant difference in total adverse events (OR = 0.82, 95%CI:0.39–1.72).Conclusion: Our analysis suggests that probiotics can be used to improve the constipation and motor symptoms for patients with Parkinson’s constipation, possibly by reducing the inflammatory response and improving gut-brain axis neuron function, whose safety also proved to be good.

Management of Gastrointestinal Symptoms in Parkinson’s Disease

“…A recent meta-analysis of 9 such studies as well as 3 single-arm studies (n=818 patients) revealed that oral probiotics resulted in improved stool frequency [odds ratio: 3.22, 95% CI (1.97, 5.29)] while decreasing the number of laxatives needed [mean difference: −0.72, 95% CI (−1.04, −0.41)] 91 . Motor function, notably, was also improved per the UPSDRS-III score [mean difference: −6.58, 95% CI (−12.02, 1.14)].…”

“…A recent meta-analysis of 9 such studies as well as 3 single-arm studies (n = 818 patients) revealed that oral probiotics resulted in improved stool frequency [odds ratio: 3.22, 95% CI (1.97, 5.29)] while decreasing the number of laxatives needed [mean difference: −0.72, 95% CI (−1.04, −0.41)]. 91 Motor function, notably, was also improved per the UPSDRS-III score [mean difference: −6.58, 95% CI (−12.02, 1.14)]. Trials of both single-strain and multi-strain probiotic formulations were included, with individual trials that demonstrated benefits ranging from those that studied only Lactobacillus strains to combinations of Lactobacillus, Bifidobacterium, and Bacillus.…”

The Effect of Gut Microbiota-Targeted Interventions on Neuroinflammation and Motor Function in Parkinson’s Disease Animal Models—A Systematic Review

“…The long-term safety of microbiota-targeted therapies in PD has yet to be thoroughly evaluated. While preliminary studies regarding the impact of probiotics on GI and motor symptoms have rendered promising results [62][63][64], longterm efficacy and safety studies [65], levodopa interaction risk evaluations [15], as well as therapeutic dose identification [62,66] are necessary. In comparison, FMT studies are more heterogeneous methodologically despite the limited data available on PD models [44]; some short-term studies attest to its effectiveness in treating gastrointestinal dysfunction and improving motor symptoms [45,46,67,68].…”

Constipation in Parkinson's Disease

“…74 Probiotics, overall, appear to increase stool frequency and improve stool consistency in PD-related constipation, though which precise formulation is optimal and exactly how these effects are mediated remain to be determined. 75 Reference has already been made to the uncertainty surrounding the impact of dopaminergic medications on bowel function in PD. One short-term study in a small number of patients provided some evidence to indicate that the potent dopaminergic agent, apomorphine, may improve anorectal and pelvic floor coordination and promote evacuation.…”

“…74 Probiotics, overall, appear to increase stool frequency and improve stool consistency in PD-related constipation, though which precise formulation is optimal and exactly how these effects are mediated remain to be determined. 75…”