Lower gastrointestinal dysfunction in patients with Parkinson's disease

Abstract

To assess the lower gastrointestinal tract dysfunction in patients with Parkinson's disease (PD) and to reveal its relationships with motor and non-motor symptoms. One hundred and eighteen patients with PD of I-III Hoehn and Yahr (H&Y) stages were studied using UPDRSI-IV, Sch&En, PDQ-39, MMSE, BDI, STAI-S and STAI-T, PFS-16, NMSQ, GSRS, BSFS, AUA. Body mass index and saliva amount and lacrimation (Schirmer's test) were assessed. Constipation from mild to moderate intensity was present in 71.2% of the patients; predominantly mild diarrhea occurred in 27.9%; alternations of diarrhea with the difficulty in intestine emptying were observed in 25.4%. We found significant correlations of constipation with the following parameters: Sch&En scales (rS=-0.291) and PDQ-39 (rS=0.478), patient's age (rS=0.275), H&Y stage (rS=0.2604), UPDRS (rS=0.254), axial motor symptoms of parkinsonism, and a number of affective and autonomic disorders, most of which were partly dopamine-resistant. Diarrhea did not affect the quality of patient's life, or depend on age, PD stage, main digital and non-motor symptoms, but directly correlated with the severity of constipation (rS=0.263) and other gastrointestinal disorders. There were no effects of dopaminergic therapy, including levodopa, dopamine-receptor-agonists, and amantadine, on the lower gastrointestinal tract dysfunction. Dysfunction of the lower gastrointestinal tract (predominantly from mild to moderate intensity) was detected in most PD patients of I-III stages. Our data indicate a complex pathogenesis of the PD impaired bowel emptying, involving degeneration of non-dopaminergic structures, and the predominant influence of concomitant diseases and inadequate laxative therapy on the formation of diarrhea syndrome in PD.