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Gastrointestinal dysfunction in Parkinson’s disease

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Abstract

Background

Gastrointestinal (GI) dysfunction is prevalent in Parkinson’s disease (PD). Symptoms are evident throughout the disease course, affect the length of the GI tract and impact on patient quality of life and management. We clarify real-life differences in the frequency and severity of GI symptoms in a cohort of PD and healthy control (HC) subjects.

Methods

103 PD patients were compared to 81 HC subjects. Outcome measures collected from validated questionnaires included constipation severity, upper and lower GI symptoms and physical activity.

Results

PD patients were three-times more likely to experience constipation than HC subjects, (78.6% vs 28.4%), exhibited a fourfold increase in constipation severity and formed harder stools. PD patients also reported increased symptoms of indigestion, nausea, excessive fullness and bloating, compared to the HCs. A higher mean Leeds Dyspepsia Questionnaire score for PD patients (8.3 (standard deviation (SD) 7.7) vs 4.6 (SD 6.1), p = 0.001)) indicated increased symptom severity. Chronic pain was more frequently reported and correlated with constipation and upper GI dysfunction, being more prevalent and severe in women. Physical activity was notably decreased in the PD cohort (1823.6 (± 1693.6) vs 2942.4 (± 2620.9) metabolic equivalent-minutes/week, p = 0.001) and correlated with constipation severity. PD therapies were associated with increased fullness and bloating and harder stools.

Conclusions

PD patients report more prevalent and severe GI dysfunction, although our cohort comprised of many later-stage participants. Earlier recognition of GI dysfunction in PD provides the opportunity to direct treatment for chronic pain and constipation, promote physical activity and rationalise PD therapies for optimal patient care.

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Acknowledgements

We thank Parkinson’s New South Wales for a Research Seed Grant. We would also like to thank all our participants. RLD is a New South Wales Health Early-Mid Career Research Fellow. CMS is the recipient of a NHMRC Practitioner Fellowship (APP1136800).

Funding

Supported by a Parkinson’s New South Wales, Research Seed Grant.

Author information

Authors and Affiliations

  1. Department of Neurology, Clinical Admin 3E, Level 3, ASB, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia

    Michal Lubomski & Carolyn M. Sue

  2. Department of Neurogenetics, Kolling Institute, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia

    Michal Lubomski, Ryan L. Davis & Carolyn M. Sue

  3. School of Medicine, The University of Notre Dame Australia, Sydney, NSW, Australia

    Michal Lubomski

Authors
  1. Michal Lubomski
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  2. Ryan L. Davis
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  3. Carolyn M. Sue
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Contributions

ML: Study design, reviewed patients, collected and analysed data, drafted and reviewed the manuscript. RLD: Study design, drafted and reviewed the manuscript. CMS: Study design, drafted and reviewed the manuscript.

Corresponding author

Correspondence to Michal Lubomski.

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Conflicts of interest

Not industry sponsored. All authors report no relevant disclosures.

Ethical standard

Ethical approval was granted by the Northern Sydney Local Health District Human Research Ethics Committee and the North Shore Private Hospital ethics committee, HREC/18/HAWKE/109, NSPHEC 2018-LNR-009, respectively. Written informed consent was obtained from all patients at the time of recruitment.

Additional information

Ryan L. Davis and Carolyn M. Sue are co-last authors.

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Lubomski, M., Davis, R.L. & Sue, C.M. Gastrointestinal dysfunction in Parkinson’s disease. J Neurol 267, 1377–1388 (2020). https://doi.org/10.1007/s00415-020-09723-5

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  • DOI: https://doi.org/10.1007/s00415-020-09723-5

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