Abstract
We determined the effectiveness of a multi-strain probiotic (Hexbio®) containing microbial cell preparation MCP®BCMC® on constipation symptoms and gut motility in PD patients with constipation. PD patients with constipation (ROME III criteria) were randomized to receive a multi-strain probiotic (Lactobacillus sp and Bifidobacterium sp at 30 X 109 CFU) with fructo-oligosaccaride or placebo (fermented milk) twice daily for 8 weeks. Primary outcomes were changes in the presence of constipation symptoms using 9 items of Garrigues Questionnaire (GQ), which included an item on bowel opening frequency. Secondary outcomes were gut transit time (GTT), quality of life (PDQ39-SI), motor (MDS-UPDRS) and non-motor symptoms (NMSS). Of 55 recruited, 48 patients completed the study: 22 received probiotic and 26 received placebo. At 8 weeks, there was a significantly higher mean weekly BOF in the probiotic group compared to placebo [SD 4.18 (1.44) vs SD 2.81(1.06); (mean difference 1.37, 95% CI 0.68, 2.07, uncorrected p<0.001)]. Patients in the probiotic group reported five times higher odds (odds ratio = 5.48, 95% CI 1.57, 19.12, uncorrected p = 0.008) for having higher BOF (< 3 to 3-5 to >5 times/week) compared to the placebo group. The GTT in the probiotic group [77.32 (SD55.35) hours] reduced significantly compared to placebo [113.54 (SD 61.54) hours]; mean difference -36.22, 95% CI -68.90, -3.54, uncorrected p = 0.030). The mean change in GTT was 58.04 (SD59.04) hour vs 20.73 (SD60.48) hours respectively (mean difference 37.32, 95% CI 4.00, 70.63, uncorrected p = 0.028). No between-groups differences were observed in the NMSS, PDQ39-SI, MDS-UPDRS II and MDS-UPDRS III scores. Four patients in the probiotics group experienced mild reversible side effects. This study showed that consumption of a multi-strain probiotic (Hexbio®) over 8 weeks improved bowel opening frequency and whole gut transit time in PD patients with constipation.
Highlights
Constipation is one of the commonest non-motor symptoms in Parkinson’s disease (PD), reported in 80–90% of patients [1] and may precede the diagnosis of PD in 25% [2]
At 8 weeks, there was a significantly higher mean weekly Bowel opening frequency (BOF) in the probiotic group compared to placebo [standard deviation (SD) 4.18 (1.44) vs SD 2.81(1.06);]
Patients in the probiotic group reported five times higher odds for having higher BOF (< 3 to 3–5 to >5 times/week) compared to the placebo group
Summary
Constipation is one of the commonest non-motor symptoms in Parkinson’s disease (PD), reported in 80–90% of patients [1] and may precede the diagnosis of PD in 25% [2]. Gut dysbiosis with alterations in faecal microbial composition was associated with the pathogenesis of PD and constipation [4,5] Effective and evidence-based treatment for constipation in PD up till recently was limited to iso-osmotic macrogol [6] and lubisprostone [7] which was shown to improve stool consistency and/or frequency. In line with gut dysbiosis, recent studies showed that probiotics therapy with or without prebiotics supplementation alleviated abdominal bloating and pain [8,9], improved stool consistency [8], improved stool frequency and the number of complete bowel movements [10]. Probiotics supplementation improved motor severity scores, metabolic profiles namely hs-CRP levels, serum glutathione levels, and body-mass-index in PD patients, compared to placebo [11]. Published randomised trials [6,7,10] with positive outcomes on constipation in PD patients had evaluated stool frequency [10] and stool consistency [6] based on stool diary, but none so far had evaluated improvement in gut transit time as part of treatment objectives
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
