Journal of Neurology

, Volume 252, Issue 9, pp 1055–1059 | Cite as

Gastric emptying after semi–solid food in multiple system atrophy and Parkinson disease

  • T. Thomaides
  • T. Karapanayiotides
  • Y. Zoukos
  • C. Haeropoulos
  • E. Kerezoudi
  • N. Demacopoulos
  • G. Floodas
  • E. Papageorgiou
  • F. Armakola
  • Y. Thomopoulos
  • I. Zaloni
ORIGINAL COMMUNICATION

Abstract

Background

Gastrointestinal symptoms such as nausea, abdominal pain, and bloating are frequent complaints in patients with Parkinson disease (PD) and in patients with multiple system atrophy (MSA), and may be associated with delayed gastric emptying (GE). Although several GE studies in patients with PD have been performed, scant data exist in patients with MSA.

Methods

We assessed GE half–times (T50) in 12 patients with MSA and compared them with those of 12 patients with PD and 12 age–matched healthy controls.GE was estimated scintigraphically using the left anterior oblique method after ingestion of a 99mTc colloid–labeled balanced semi–solid meal (yogurt). GE data were obtained every 15 minutes until there was complete emptying of the stomach. Blood pressure, heart rate, plasma glucose and glucosylated hemoglobin were regularly determined.

Results

Reproducibility of the GE technique was excellent (Bland–Altman analysis, limits of agreement: –2.3 to 2.8). T50 was longer in MSA (82 ± 3.4 min) and in PD (90.6 ± 3.9 min) patients compared with controls (46.2 ± 0.7) (two–way ANOVA, p <0.0001). T50 did not differ between patients with MSA and those with PD. No correlation existed between T50 and age, duration of the disease, magnitude of postprandial hypotension, levels of plasma glucose and glucosylated hemoglobin (Kendall’s tau, p > 0.05).

Conclusions

Our results suggest that patients with MSA have GE rates similar to those of patients with PD, but slower than healthy agematched individuals. It remains to be investigated whether gastrointestinal dysfunction in MSA is related to both brain and peripheral pathology, as is presumed for PD.

Key words

multiple system atrophy Parkinson disease gastric emptying 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Chaudhuri KR, Hu M (2000) Central autonomic dysfunction. In:Vinken PJ, Bruyn GW, Appenzeller O (eds) Handbook of clinical neurology. The autonomic nervous system part II – Dysfunction. Elsevier Science, Amsterdam, pp 161–202Google Scholar
  2. 2.
    Chaudhuri KR, Love-Jones S, Thomaides T, Clift S, Mathias CJ, et al. (1997) Postprandial hypotension and parkinsonian state in Parkinson’s disease. Mov Disord 12:877–884CrossRefPubMedGoogle Scholar
  3. 3.
    Djaldetti R, Baron J, Ziv I, Melamed E (1996) Gastric emptying in Parkinson’s disease: Patients with and without response fluctuations. Neurology 46:1051–1054PubMedGoogle Scholar
  4. 4.
    Edwards LL, Quigley EM, Pfeiffer RF (1992) Gastrointestinal dysfunction in Parkinson’s disease: frequency and pathophysiology. Neurology 42:726–732PubMedGoogle Scholar
  5. 5.
    Evans MA, Broe GA, Triggs EJ, Cheung M, Creasey H, et al. (1981) Gastric emptying rate and the systemic availability of levodopa in the elderly parkinsonian patient. Neurology 31:1288–1294PubMedGoogle Scholar
  6. 6.
    Ewing DJ, Clarke BF (1982) Diagnosis and management of diabetic autonomic neuropathy. BMJ 285:916–918PubMedGoogle Scholar
  7. 7.
    Ford PV, Kennedy RL, Vogel JM (1992) Comparison of left anterior oblique, anterior and geometric mean methods for determining gastric emptying times. J Nucl Med 33:127–130PubMedGoogle Scholar
  8. 8.
    Gilman S, Low PA, Quinn N, Albanese A, Ben-Shlomo Y, et al. (1999) Consensus statement on the diagnosis of multiple system atrophy. J Neurol Sci 163:94–98CrossRefPubMedGoogle Scholar
  9. 9.
    Goldstein DS, Holmes C, Li ST, Bruce S, Metman LV, Cannon RO 3rd (2000) Cardiac sympathetic denervation in Parkinson disease. Ann Intern Med 133:338–347PubMedGoogle Scholar
  10. 10.
    Handoff R, Sula M, Tamir A, Soil A, Front A, et al. (2001) Gastric emptying time and gastric motility in patients with Parkinson’s disease. Mov Disord 16:1044–1047Google Scholar
  11. 11.
    Jost WH (1997) Gastrointestinal motility problems in patients with Parkinson’s disease. Effects of antiparkinsonian treatment and guidelines for management. Drugs Aging 10:249–258PubMedGoogle Scholar
  12. 12.
    Kaneoke Y, Koike Y, Sakurai N, Washimi Y, Hirayama M, et al. (1995) Gastrointestinal dysfunction in Parkinson’s disease detected by electrogastroenterography. J Auton Nerv Syst 50:275–281CrossRefPubMedGoogle Scholar
  13. 13.
    Kelly KA (1981) Motility of the stomach and gastroduodenal junction. In: Johnson LR (ed) Physiology of the gastrointestinal tract. New York, Raven Press, pp 393–410Google Scholar
  14. 14.
    Krygowska-Wajs A, Lorens K, Thor P, Szczudlik A, Konturek S (2000) Gastric electromechanical dysfunction in Parkinson’s disease. Funct Neurol 15:41–46PubMedGoogle Scholar
  15. 15.
    Kupsky WJ, Grimes MM, Sweting J, Bertsch R, Cote LJ (1987) Parkinson’s disease and megacolon: concentric hyaline inclusions (Lewy bodies) in enteric ganglion cells. Neurology 37:1253–1255PubMedGoogle Scholar
  16. 16.
    Lanfranchi GA, Marzio L, Cortini C, et al. (1977) Effect of dopamine in gastric motility in man: evidence for specific receptors. In: Duthie HL (ed) Gastrointestinal motility in health and disease. Lancaster, England, MTP Publishers, pp 161–172Google Scholar
  17. 17.
    Malmud LS, Fisher RS, Knight LC, Rock E (1982) Scintigraphic evaluation of gastric emptying. Semin Nucl Med 12:116–125PubMedGoogle Scholar
  18. 18.
    Martigoni E, Paccheti C, Godi L, Micieli G, Nappi G (1995) Autonomic disorders in Parkinson’s disease. J Neural Transm (Suppl) 45:11–19Google Scholar
  19. 19.
    Mathias CJ (1991) Postprandial hypotension: pathophysiological mechanisms and clinical implications in different disorders. Hypertension 18:694–704PubMedGoogle Scholar
  20. 20.
    Mathias CJ, Bannister R (1999) Postprandial hypotension in autonomic disorders. In:Mathias CJ, Bannister R (eds) Autonomic failure: a textbook of clinical disorders of the autonomic nervous system. Oxford, Oxford University Press, pp 283–295Google Scholar
  21. 21.
    Mathias CJ, Bannister R (1999) Investigation of autonomic disorders. In: Mathias CJ, Bannister R (eds) Autonomic failure: A textbook of clinical disorders of the autonomic nervous system. Oxford, Oxford University Press, pp 169–195Google Scholar
  22. 22.
    Nishie M, Mori F, Fujiwara H, Hasegawa M, Yoshimoto M, et al. (2004) Accumulation of phosphorylated alpha-synuclein in the brain and peripheral ganglia of patients with multiple system atrophy. Acta Neuropathol (Berl)107:292–298CrossRefPubMedGoogle Scholar
  23. 23.
    O’ Donovan D, Feinle C, Tonkin A, Horowitz M, Jones KL (2002) Postprandial hypotension in response to duodenal glucose delivery in healthy older subjects. J Physiol 540:673–679CrossRefPubMedGoogle Scholar
  24. 24.
    Soykan I, Sarosiek I, Shifflet J, Wooten GF, McCallum RW (1997) Effect of chronic oral domperidone therapy on gastrointestinal symptoms and gastric emptying in patients with Parkinson’s disease. Mov Disord 12:952–957CrossRefPubMedGoogle Scholar
  25. 25.
    Schuurkes JA, Van-Neuten JM (1981) Is dopamine an inhibitor modulator of gastrointestinal motility? Scand J Gastroenterol (Suppl) 67:33–36Google Scholar
  26. 26.
    Thomaides T, Bleasdale-Barr K, Chaudhuri KR, Pavitt D, Marsden CD, et al. (1993) Cardiovascular and hormonal responses to liquid food challenge in idiopathic Parkinson’s disease, multiple system atrophy and pure autonomic failure. Neurology 43:900–904PubMedGoogle Scholar
  27. 27.
    Vitti RA, Malmud LS, Fisher RS (1984) In: Freeman LM (ed) Clinical radionuclide Imaging. New York, Grune and Stratton, pp 1694–1728Google Scholar
  28. 28.
    Wakabayashi K, Takahashi H, Takeda S, Ohama E, Ikuta F (1988) Parkinson’s disease: the presence of Lewy bodies in Auerbach’s and Meissner’s plexuses. Acta Neuropathol (Berl) 76:217–221CrossRefPubMedGoogle Scholar

Copyright information

© Steinkopff-Verlag 2005

Authors and Affiliations

  • T. Thomaides
    • 1
  • T. Karapanayiotides
    • 1
  • Y. Zoukos
    • 2
  • C. Haeropoulos
    • 3
  • E. Kerezoudi
    • 4
  • N. Demacopoulos
    • 5
  • G. Floodas
    • 1
  • E. Papageorgiou
    • 1
  • F. Armakola
    • 1
  • Y. Thomopoulos
    • 1
  • I. Zaloni
    • 1
  1. 1.Dept. of NeurologyPammakaristos HospitalAthensGreece
  2. 2.Dept. of NeurologyRoyal London HospitalLondonUK
  3. 3.Dept. of NeurologyNIMTS HospitalAthensGreece
  4. 4.Dept. of NeurologyPolikliniki HospitalAthensGreece
  5. 5.Dept. of Nuclear MedicineNIMTS HospitalAthensGreece

Personalised recommendations