Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease. Patients show deposits of pathological, aggregated α-synuclein not only in the brain but throughout almost the entire length of the digestive tract. This gives rise to non-motor symptoms particularly within the gastrointestinal tract and patients experience a wide range of frequent and burdensome symptoms such as dysphagia, bloating, and constipation. Recent evidence suggests that progressive accumulation of gastrointestinal pathology is underway several years before a clinical diagnosis of PD. Notably, constipation has been shown to increase the risk of developing PD and in contrast, truncal vagotomy seems to decrease the risk of PD. Animal models have demonstrated gut-to-brain spreading of pathological α-synuclein and it is currently being intensely studied whether PD begins in the gut of some patients. Gastrointestinal symptoms in PD have been investigated by the use of several different questionnaires. However, there is limited correspondence between subjective gastrointestinal symptoms and objective dysfunction along the gastrointestinal tract, and often the magnitude of dysfunction is underestimated by the use of questionnaires. Therefore, objective measures are important tools to clarify the degree of dysfunction in future studies of PD. Here, we summarize the types and prevalence of subjective gastrointestinal symptoms and objective dysfunction in PD. The potential importance of the gastrointestinal tract in the etiopathogenesis of PD is briefly discussed.
Highlights
Parkinson’s disease (PD) is the second most common neurodegenerative disease affecting 2–3% of the population above 65 years of age [1]
Subjective gastrointestinal symptoms are common in PD and the prevalence of objectively measured dysfunction is even higher
Oropharyngeal dysphagia is often asymptomatic during the early stages, and since it improves with levodopa treatment, it is often viewed as a motor symptom
Summary
Parkinson’s disease (PD) is the second most common neurodegenerative disease affecting 2–3% of the population above 65 years of age [1]. NMS attributable to the digestive system are common and dysfunction along the entire length of the digestive tract give rise to symptoms such as dysphagia, bloating, early satiety, and constipation [4]. Pathological aggregates of α-synuclein have been detected in gastrointestinal tissues removed several years prior to clinical diagnosis of PD [7], and epidemiological studies have shown that truncal vagotomy decreases the risk of PD by 40–50% [8,9]. It is of considerable importance to unravel the etiopathogenic role of the gastrointestinal tract in PD, and to improve our understanding and assessment methods of subjective gastrointestinal symptoms and objective gastrointestinal dysfunction. The current approaches to treatment of gastrointestinal symptoms in PD will be briefly touched upon
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