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Constipation in Parkinson’s Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle?

  • Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
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Abstract

Purpose of Review

Chronic constipation is a common, nonmotor, and prodromal symptom in Parkinson’s disease (PD). Its underlying neuropathology may provide pathophysiological insight into PD. Here, we critically review what is currently known about the neuroanatomical and brain-gut interactions, and the origin and progression of Lewy pathology (LP) at three levels—brain/brainstem, spinal cord, and enteric nervous system.

Recent Findings

Many recent studies have illustrated the challenges of examining LP in tissues obtained from colon biopsies of PD patients. Large-scale epidemiological studies have not confirmed the widely accepted Braakpostula.

Summary

In this review, we propose an alternative origin and route of spread of LP in PD. We describe novel, noninvasive neurophysiological testing that could advance the understanding of LP and complex bidirectional brain-pelvic floor neural pathways in PD—a true disease model of a neurogastrointestinal disorder. This review may provide the impetus for future studies investigating gut and brain interaction and constipation in PD.

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Acknowledgements

We would like to acknowledge research support provided by the Parkinson’s Foundation through the 2017 CCRA Translational Clinical Research Grant. Furthermore, we would like to acknowledge Joe Kelley and the CSRA Parkinson Support Group for their engagement and support of our research.

Financial Disclosures

Amol Sharma serves on the advisory board for Ironwood Pharmaceuticals. JCM has received honoraria for speaking for Acadia, Impax, and Teva. He has served as a consultant for Acadia, Cynapsus, Impax, Neurocrine, Parkinson’s Foundation, and Teva. He has also received compensation for serving as an expert witness in various neurological legal cases. He has served as a site PI or sub-I for clinical trials with Abbvie, Acadia, Acorda, Biotie, CHDI, Cynapsus, Impax, Kyowa, Lilly, Lundbeck, NIH, Parkinson’s Foundation, PSG, Roche, and Serina. SSCR received research support from Ironwood/Forrest Pharmaceuticals and Intone Medical. SSCR serves on the advisory board for Ironwood/Forrest Pharmaceuticals, Synergy Pharmaceuticals, Salix Pharmaceuticals, Orphomed, and Vibrant Ltd.

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  1. Division of Gastroenterology/Hepatology, Medical College of Georgia, Augusta University Medical Center, 1120 15th Street, AD-2226, Augusta, GA, 30912, USA

    Amol Sharma & Satish S. C. Rao

  2. Parkinson’s Foundation Center of Excellence, Movement Disorders Program, Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA

    Julie Kurek & John C. Morgan

  3. Department of Physical Therapy, College of Allied Health Sciences, Augusta University & Charlie Norwood VAMC, Augusta, GA, USA

    Chandramohan Wakade

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  1. Amol Sharma
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Correspondence to Amol Sharma.

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This article is part of the Topical Collection on Neurogastroenterology and Motility Disorders of the Gastrointestinal Tract

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Sharma, A., Kurek, J., Morgan, J.C. et al. Constipation in Parkinson’s Disease: a Nuisance or Nuanced Answer to the Pathophysiological Puzzle?. Curr Gastroenterol Rep 20, 1 (2018). https://doi.org/10.1007/s11894-018-0609-x

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