Irritable Bowel Syndrome and Risk of Parkinson's Disease in Finland: A Nationwide Registry-Based Cohort Study.

Anna But,Filip Scheperjans,Tuomas H. Mertsalmi,Eero Pekkonen

doi:10.3233/jpd-202330

Anna But, Filip Scheperjans + Show 2 more

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https://doi.org/10.3233/jpd-202330

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Journal: Journal of Parkinson's disease	Publication Date: Feb 23, 2021
Citations: 13	License type: CC BY 4.0

Affiliation: University of Helsinki

Abstract

Background:The gastrointestinal tract is considered as a potential origin of Parkinson’s disease (PD) pathology. Besides constipation, appendectomy and inflammatory bowel disease have also been associated with a higher PD-risk, but findings have been inconsistent. To date, there is only one previous study suggesting that irritable bowel syndrome (IBS) is associated with an increased risk of PD.Objective:To evaluate whether IBS is associated with a higher risk of PD.Methods:In this retrospective registry-based cohort study, we identified 28,150 patients that were diagnosed with IBS (IBS+) during the years 1998–2014, using data from the Finnish Care Register for Health Care. In addition, 98,789 IBS-free reference subjects (IBS-) of same age and gender and living in the same municipality were included. The study subjects were followed until the end of the year 2014 to analyze the incidence of PD. The association between IBS and PD was assessed by a Cox proportional hazards model.Results:Diagnosis of IBS was associated with a higher hazard of PD with an adjusted hazard ratio (aHR) of 1.70 (95% CI 1.27–2.26). However, the ratio of hazard rates for PD between IBS+ and IBS- subjects was not constant over time. The Cox model with time-varying coefficient for IBS status showed that the hazard of PD was significantly higher in IBS patients only during the first two years of follow-up (aHR 2.96, 95% CI 1.78–4.92).Conclusion:Our findings indicate that the association between IBS and PD is likely explained by reverse causation and detection bias. It remains open whether IBS is an actual risk factor or a prodromal symptom of PD.

Highlights

Patients with Parkinson’s disease (PD) may suffer from multiple non-motor symptoms, including gastrointestinal dysfunction, hyposmia, and REM sleep behavior disorder
In the univariate Cox model, the hazard ratios (HR) for PD was 1.65 for irritable bowel syndrome (IBS)+ subjects compared with IBS- subjects (Fig. 2)
In this observational register-based follow-up study on the large cohort of IBS patients and an IBS-free reference subjects (IBS-)free reference population, we found an association between IBS and an increased hazard of PD only during

Summary

Introduction

Patients with Parkinson’s disease (PD) may suffer from multiple non-motor symptoms, including gastrointestinal dysfunction, hyposmia, and REM sleep behavior disorder. With a reported prevalence of up to 80%, constipation is considered the most common non-motor symptom in PD, emerging up to 20 years before the onset of motor symptoms [1] It is recognized as a significant risk factor for PD [2, 3]. The Cox model with time-varying coefficient for IBS status showed that the hazard of PD was significantly higher in IBS patients only during the first two years of follow-up (aHR 2.96, 95% CI 1.78–4.92). Conclusion: Our findings indicate that the association between IBS and PD is likely explained by reverse causation and detection bias It remains open whether IBS is an actual risk factor or a prodromal symptom of PD

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Conclusion