Probiotics and prebiotic fiber for constipation associated with Parkinson disease

Abstract

This study provides Class I evidence that for patients with PD who have constipation, fermented milk containing probiotics and prebiotics increases the frequency of CBMs.

A focus on Rome III criteria for the assessment of constipation in Parkinson's disease

“…As highlighted by Knudsen and colleagues, a major shortcoming of the use of Rome III criteria in PD is the lack of studies . However, using these criteria, our research group published 4 studies (2 after February 2016), including a randomized trial on the use of prebiotics and probiotics as adjuvant therapy for constipation . In the first 3 studies, we found a prevalence of constipation ranging between 47% to 60% (pooled prevalence, 51%), which is consistent with the pooled estimates provided by the Danish colleagues.…”

“…Finally, in our randomized clinical trial, we also provided—for the first time in a PD patient population—an indirect validation of this tool and a focus on the reliability of subjectively reported constipation. In particular, we observed that 120 out of 165 patients (73%) initially self‐reporting constipation had the diagnosis confirmed on the basis of the stool diary completed during the 2‐week pretreatment phase . Therefore, among PD patients, not only the prevalence of objective colonic dysfunction exceeds the prevalence of subjective constipation but also an overreporting of the symptom does exist.…”

“…Nonetheless, the panel also expressed a positive opinion on the use of Rome III criteria being developed through international consensus and widely accepted in the gastroenterological community. A main advantage is that they address anorectal dysfunction, which we found to be reported by around 75% of patients with constipation …”

Update on treatments for nonmotor symptoms of Parkinson's disease—an evidence‐based medicine review

“…Probiotics and prebiotic fiber were evaluated in 1 high‐quality, positive study . The new conclusions are “ efficacious ” and “ clinically useful .” There are no safety concerns, and given their wide availability and over‐the‐counter use in many countries, probiotics and prebiotic fiber are considered to pose an “ acceptable risk without specialized monitoring .”…”

“…A total of 3 new studies 12,39,40 were included for the treatment of gastrointestinal dysfunction in PD, and trials not fulfilling the inclusion criteria for review were excluded. 53,56,105 See Table 8 for recommendations.…”