Utility of high-resolution anorectal manometry and wireless motility capsule in the evaluation of patients with Parkinson's disease and chronic constipation

Abstract

BackgroundThe aetiology of constipation in Parkinson's disease remains poorly understood. Defaecatory dyssynergia, anal sphincter spasticity and slow transit constipation may, individually or collectively, play a role.AimsIn this retrospective cohort analysis of patients with Parkinson's disease and chronic constipation, we determined the utility of high-resolution anorectal manometry, balloon expulsion and wireless motility capsule testing in defining the underlying aetiology for constipation.MethodsIn this retrospective cohort study, consecutive patients with Parkinson's disease and chronic constipation underwent clinical assessment, manometry with balloon expulsion and wireless motility capsule testing using standard protocols.ResultsWe studied 66 patients fulfilling Rome IV criteria for functional constipation. Most patients (89%) had abnormal manometry, exhibiting various types of defaecatory dyssynergia (mostly types II and IV), abnormal balloon expulsion, diminished rectal sensation and, in some, lacking rectoanal inhibitory reflex. 62% exhibited colonic transit delay by wireless motility capsule study, while 57% had combined manometric and transit abnormalities, suggesting of overlap constipation. Symptoms of infrequent defaecation, straining and incomplete evacuation were not discriminatory. There was a relationship between constipation scores and colonic transit times (p=0.01); Parkinson's disease scores and duration were not correlated with either the manometric or transit findings. Faecal incontinence was seen in 26% of the patients.ConclusionsChronic constipation in patients with Parkinson's disease may reflect pelvic floor dyssynergia, slow transit constipation or both, and may be associated with faecal incontinence, suggesting both motor and autonomic dysfunction. Anorectal manometry and wireless motility capsule testing are useful in the assessment of these patients.

Fecal Calprotectin as a Marker of the Gut Immune System Activation Is Elevated in Parkinson’s Disease

“…In particular, feeling of incomplete evacuation might be considered as a marker of visceral hypersensitivity, possibly associated with the gut-immune system activation and constituting a characteristic feature of the disorders of gut-brain interactions such as IBS (Drossman, 2016). Moreover, incomplete evacuation and excessive straining belong to the spectrum of defecatory dysfunction, which has been recently confirmed in PD using high resolution anorectal manometry (Su et al, 2016).…”

Colonic transit, high-resolution anorectal manometry and MRI defecography study of constipation in Parkinson's disease

“…Previous manometric assessment in patients with PD have shown abnormalities of anorectal dysfunction in a great proportion of patients, even at early stages of the disease, with a heterogeneous pattern between studies including rectal hyposensitivity and several motor abnormalities of sphincter pressure or contractility (dyssynergia) [3,4,6,22,23,25] although only two of them incorporated high-resolution manometry. [5,9] Taken together, in addition to methodological differences and incorporation of more sensitive high-resolution equipment that may contribute to variability of results, these findings indicate that pathophysiology of defecatory dysfunction in PD is complex with multiple heterogeneous overlapping mechanisms and rectal hyposensitivity and poor evacuatory function due to dyssynergia were the most common patterns in this study.…”

“…When analysed together, defecatory dysfunction seem more prevalent than isolated slow transit constipation. Only a very few studies have evaluated colonic transit and anorectal dysfunction simultaneously and their results agree with a predominant role for anorectal dysfunction although either manometric parameters without additional defecography were used [9,22] or studies were conducted decades ago using historical diagnostic techniques. [23] Based on the results of the current and previous studies on PD, and evidence from studies pathophysiology and the overlap between pathological and physiological parameters.…”

“…[3][4][5][6] These investigations are of little clinical utility when individually performed because of the difficulties in interpreting the results given the overlap between health and disease, the lack of correlation between a single physiological abnormality and symptoms, and the commonly multifactorial cause of the problem. [7,8] Additionally, most of these studies were performed a few decades ago with conventional historical diagnostic techniques and, with a few exceptions reporting results using highresolution ARM, [5,9] more recent studies have not incorporated technological advances.…”

Niacin and Butyrate: Nutraceuticals Targeting Dysbiosis and Intestinal Permeability in Parkinson’s Disease

“…Constipation, the most common GI symptom, often precedes motor symptom onset by more than 15 years; increasing constipation severity corresponds to a 3.3–4.2 hazards ratio for subjects developing PD [ 22 , 23 , 24 ]. Chronic constipation in PD patients is a multifaceted brain-gut and neuromuscular disorder related to dysbiosis, efferent brain–anal axis neuropathy, visceral hypersensitivity, intestinal methanogen overgrowth, rectal hyposensitivity, and anorectal incoordination [ 25 , 26 , 27 ].…”