Inflammatory bowel disease and risk of Parkinson’s disease

Abstract

We read with interest the paper by Camacho-Soto et al., based on Medicare data [ [1] Camacho-Soto A. Gross A. Nielsen S.S. et al. Inflammatory bowel disease and risk of Parkinson's disease in Medicare beneficiaries. Park. Relat. Disord. 2018 May; 50: 23-28 Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar ]. In their case-control study of Parkinson's disease (PD) risk, they observed an inverse association between PD and inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC). They also reported that PD was inversely associated with IBD-associated conditions and with IBD-associated surgical procedures and immunosuppressant use, even among Medicare beneficiaries without IBD. They found IBD to be associated with a lower risk of developing PD in the adjusted model for a population aged> 65 years (OR 0.86, 95% CI 0.81–0.92). Our group published a contribution on this issue from a cross-sectional study based on the electronic prescribing system of the Andalusian public health system (covers 98% of prescriptions), which included all subjects aged ≥ 50 years receiving medication during December 2014 [ [2] Escamilla-Sevilla F. Pinel-Ríos J. Madrid-Navarro C.J. et al. Are inflammatory bowel disease and/or treatment with aminosalicylates protective factors against Parkinson's disease?. Mov. Disord. 2016; 31 (S141) Google Scholar ]. Patients were identified as “possible PD” when they received antiparkinson drugs (excluding those receiving only one low-dose dopaminergic agonist) and as “possible IBD” when they received aminosalicylates (mesalazine, sulfasalazine, or 5-ASA). Our results indicated that the presence of IBD and/or treatment with 5-ASA may play a protective role against PD development, especially among under-65-year-olds (OR 0.28, 95% CI 0.10–0.74), similar to observations in individuals with truncal vagotomy [ [3] Svensson E. Horváth-Puhó E. Thomsen R.W. et al. Vagotomy and subsequent risk of Parkinson's disease. Ann. Neurol. 2015; 78: 522-529 Crossref PubMed Scopus (494) Google Scholar ]. Another large population-based cohort study in Taiwan [ [4] Lin J.C. Lin C.S. Hsu C.W. Lin C.L. Kao C.H. Association between Parkinson's disease and iInflammatory bowel disease: a nationwide Taiwanese retrospective cohort study. Inflamm. Bowel Dis. 2016; 22: 1049-1055 Crossref PubMed Scopus (119) Google Scholar ] reported that IBD was positively associated with PD, although there was a relative reduction in PD risk among patients with longer follow-up times and in under-65 year-olds, as in our study. These findings suggest that IBD treatment may lessen the risk of PD or delay its onset, among other possibilities. Inflammatory bowel disease and risk of Parkinson's disease in medicare beneficiariesParkinsonism & Related DisordersVol. 57PreviewWe thank Dr. Javier Pinel Ríos and colleagues for their interest in our manuscript [1] and for their interesting and supportive findings [2]. Both analyses indicated an inverse association between Parkinson's disease (PD) and inflammatory bowel disease (IBD), despite little difference in ages among PD patients with or without IBD. Similarly, in a more recently published analysis from our group [3], we also observed a modestly lower risk of PD in those taking immunosuppressants. There was some evidence that sulfasalazine, and especially mesalamine, might be associated with a modestly lower risk of PD. Full-Text PDF