Real‐time visualization of altered gastric motility by magnetic resonance imaging in patients with Parkinson's disease

Abstract

Gastrointestinal motility is frequently affected in Parkinson's disease (PD) and has even been reported in early stages of PD. We hypothesized that gastric motility can be assessed in vivo by real-time magnetic resonance imaging (MRI), an established, noninvasive method. After an overnight fast and a standardized test meal, 10 patients with PD (six drug naïve, four treated) and 10 healthy volunteers underwent real-time MRI scanning of the stomach. Gastric motility was quantified by calculating the gastric motility indices (GMI) from transversal oblique und sagittal oblique MRI scans. There was a trend toward a decreased gastric motility in patients with PD compared with healthy controls (Mann-Whitney test, P 0.059). This difference in peristalsis was due to a significant reduction in the amplitude of peristaltic contractions (P 0.029) and not to a decelerated velocity of the peristaltic waves (P 0.97). Real-time MRI allows direct visualization of gastric motility in PD. In this pilot study, a relatively high interindividual variability impaired accurate separation of our PD sample from healthy controls. The trend toward decreased gastric motility is in accordance with previous studies that investigated gastric motility in patients with PD using other methods. Our study provides first demonstration of a possible underlying mechanism for disturbed gastric motility in PD (reduced amplitude of contractions versus altered velocity of peristaltic waves). Further studies in drug-naïve PD patients are required to determine the discriminatory power and validity of this technique in PD.

Autonomic involvement in Parkinson's disease: Pathology, pathophysiology, clinical features and possible peripheral biomarkers

“…Delayed gastric emptying and gastric retention resulting in nausea, early satiety, bloating and abdominal distension are common complaints in PD patients, even in those not receiving dopaminergic replacement therapy [80][81][82][83]. Delayed gastric emptying can be documented in a large percentage of PD patients [101] even at an early stage of disease [105]; reduced amplitude of stomach contractions in PD can be detected using real-time magnetic resonance imaging [106]. However, symptoms of upper gastrointestinal dysfunction do not always correlate with objective measurements of gastroparesis [107].…”

Postprandial ghrelin response is reduced in patients with Parkinson’s disease and idiopathic REM sleep behaviour disorder: a peripheral biomarker for early Parkinson’s disease?

“…Based on these four findings, ghrelin's role in gastric motility and its relation to the vagal system, the demonstration of reduced gastric motility in early PD [10,23], the early Lewy body neuropathology in the dorsal motor nucleus of the vagal nerve, and the fact that iRBD patients are individuals at risk to develop PD [11,20], we hypothesized that ghrelin excretion might be disturbed in PD and also in iRBD, a potential premotor stage of PD, and thus this peptide might be suitable as a peripheral biomarker for early PD.…”

“…According to Braak's hypothesis of a postulated temporal course of PD pathology in stages [5,6], the nigral degeneration reflects stage III, whereas the pre-motor stages I and II show neuropathological changes in the olfactory bulb and cortex, the brainstem with its sleep regulatory centres and the dorsal motor nucleus of the vagal nerve (a major source of parasympathetic innervation of the gastrointestinal tract). Accordingly, besides motor symptoms, PD patients frequently exhibit non-motor symptoms such as hyposmia, REM sleep behaviour disorder (RBD) and disturbed gastrointestinal motility [17,23] very early in the course of the disease. In relation to the gastrointestinal tract, the stomach has been proposed as one possible ignition point of PD related neuropathology.…”

Imaging the Gastrointestinal Tract of Small Animals

“…MRI has emerged as a diagnostic modality for the evaluation of patients with inflammatory bowel disease and contrast-enhanced imaging permits the identification of healthy and inflamed colon tissue in mouse models of human bowel diseases [24]. Real-time MRI has also been applied to measure GI tract motility, recently in patients with Parkinson’s disease [34]. Colon wall thickness can also be evaluated.…”