Nonmotor gastrointestinal disorders in older patients with Parkinson’s disease: is there hope?

Abstract

Despite the fact that nonmotor symptoms (NMS) like gastrointestinal (GI) complaints are frequently reported in Parkinson’s disease (PD), no therapeutic guidelines are available. This study aimed to manage some lower GI-NMS in a group of patients with PD. A total of 40 patients (17 males, 23 females; mean age 76.05±2.09 years) were randomly selected for this study. Patients were confirmed to have PD (modified Hoehn–Yars scale: 2.075±0.4) who had undergone levodopa or dopamine agonist treatment. In the non-motor symptoms questionnaire (NMS-Quest), regarding GI complaints, the following were recorded: abdominal pain, bloating, and constipation of mild-to-moderate severity. Laboratory studies, abdominal ultrasound, and upper and lower digestive endoscopies were performed to rule out organic issues. All patients increased their water intake to 2 L/d and alimentary fiber to 20–25 g/d. Twenty patients received trimebutine 200 mg three times daily half an hour before meals. The other 20 patients received probiotics (60 mg per-tablet of two lactic bacteria: Lactobacillus acidophilus and Bifidobacterium infantis), 2×/d, 1 hour after meals for 3 months along with the reassessment of GI complaints. Our results demonstrated that there were significant statistical differences in all assessed symptoms in the first group: 1.55±0.51 vs 0.6±0.5 (P<0.0001) for abdominal pain; 1.6±0.5 vs 0.45±0.51 (P<0.0001) for bloating; and 1.5±0.51 vs 0.85±0.67 (P=0.0014) for constipation with incomplete defecation. The second group displayed statistical differences only for abdominal pain 1.45±0.51 vs 1.05±0.69 (P=0.00432) and bloating 1.4±0.5 vs 0.3±0.47 (P<0.0001). For constipation with incomplete defecation, there was a slight improvement. Thus, there was no significant statistical difference: 1.35±0.49 vs 1.15±0.49 (P=0.2040). In conclusion, lower GI-NMS are frequently present, isolated or associated with other autonomic issues, even before the diagnosis of PD. Treatment with probiotics could improve abdominal pain and bloating as much as with trimebutine, but less for constipation with incomplete evacuation, where trimebutine showed better results.

The significance of uric acid in the diagnosis and treatment of Parkinson disease

“…Despite characterized by motor issues such as tremor at rest, rigidity, bradykinesia, PD also carries various types of NMS, [ 39 , 40 ] which are a supplementary burden and are often very difficult to manage satisfactorily. [ 41 ] Reports have examined the relations between UA levels and cognition in PD patients.…”

Probiotics Alleviate the Progressive Deterioration of Motor Functions in a Mouse Model of Parkinson’s Disease

“…These results are paralleled with PD human studies showing the positive effects in MDS-UPDRS scores of PD patients after a 12-week administration of probiotics [29], encouraging further research into its therapeutic application. Other human studies have also shown several beneficial effects of probiotics in PD, including the alleviation of the symptoms in abdominal pain, bloating, and constipation and the improvements in stool consistency and defecation habits [28,48,49]. It has been increasingly reported that the gut microbial dysbiosis and alteration of microbial metabolites could play a role in the pathogenesis of PD.…”

High-throughput 16S rRNA gene sequencing reveals that 6-hydroxydopamine affects gut microbial environment

“…Non-motor manifestations, which precede the motor disabilities in PD patients, play a key role in the disease progression and evidence for their significance has gradually accumulated [2–4]. Among the non-motor symptoms of PD, gastrointestinal (GI) dysfunction, including drooling, impaired gastric emptying, and constipation are frequently reported [5, 6].…”