Patients with Inflammatory Bowel Disease Are at an Increased Risk of Parkinson's Disease: A South Korean Nationwide Population-Based Study.

Seona Park,Jihye Kim,Jong Pil Im,Jaeyoung Chun,Joo Sung Kim,Hyun Jung Lee,Kyungdo Han,Hosim Soh,Eun Ae Kang

doi:10.3390/jcm8081191

Abstract

Background and Aims: It is not known whether inflammatory bowel disease (IBD) enhances the risk of Parkinson’s disease (PD) or whether PD diagnosis is the result of increased health care use. We determined the risk of developing PD among patients with IBD in terms of health care and medication use. Methods: A nationwide population-based study was conducted using claims data from the Korean National Health care Insurance service. From 2010 to 2013, patients with Crohn’s disease (CD) and ulcerative colitis (UC) were identified through both International Classification of Disease, Tenth Revision (ICD-10) and national rare intractable disease (RID) registration program codes. We compared 38,861 IBD patients with age and sex-matched non-IBD individuals at a ratio of 1:3. Patients with newly diagnosed PD were identified through both ICD-10 and RID codes. Results: The incidence of PD among patients with IBD was 49 per 100,000 person-years. The risk of developing PD in patients with IBD was significantly higher than controls even after adjustment for health care use (adjusted hazard ratio (aHR), 1.87; P < 0.001). Compared to controls, the risk of PD was significantly higher in patients with CD (aHR, 2.23; P = 0.023) and UC (aHR, 1.85; P < 0.001). Corticosteroid use showed a preventive effect on developing PD in patients with CD (aHR 0.08; P < 0.001), but not UC (aHR, 0.75; P = 0.213). Among 2110 patients receiving anti-tumor necrosis factor (anti-TNF), none of the treated patients experienced PD during 9950 person-years. Conclusion: Patients with IBD are at an increased risk of PD, regardless of health care use. Corticosteroid and anti-TNF use may prevent PD in patients with IBD.

Highlights

Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is characterized by the premature loss of dopaminergic neurons in the substantia nigra and abnormal aggregates of the α-synuclein protein, affecting 1% of people over 60 years of age
SuInbgtrhoiuspsuAbngarlyosuisp analysis, we evaluated differences in the risk of PD according to age, sex, and comorbidities of patients with Crohn’s disease (CD) and ulcerative colitis (UC) after adjustment for age, sex, place of residence, income leveIln, cthoims osurbbigdriotiueps ainncalluydsiisn,gwDe eMv,alhuyapteedrtdeniffsieornen, cdeyssilniptihdeemrisika,odf ePpDreascscioornd, instgrotokea,gem, yseoxc,aardnidal cionmfaorrcbtiiodnitiaens dofipscahtieemntiscwhietahrCt dDisaenadseU
In this nationwide population-based study of approximately 160,000 Korean individuals, including 39,000 patients with inflammatory bowel disease (IBD) during a mean follow-up of 5 years, we demonstrated that patients with IBD were 1.9 times significantly more likely to develop PD compared to non-IBD age- and sex-matched controls, even after adjustment for health care visits and comorbidities

Summary

Introduction

Parkinson’s disease (PD) is the second most common neurodegenerative disorder and is characterized by the premature loss of dopaminergic neurons in the substantia nigra and abnormal aggregates of the α-synuclein protein, affecting 1% of people over 60 years of age. Accumulating evidence has demonstrated that systemic inflammation is closely linked to the pathogenesis of PD, which suggests that chronic inflammation in peripheral organs may contribute to neurodegeneration in PD by altering blood–brain barrier permeability [7,8] Peripheral cytokines, such as interleukin (IL)-6, tumor necrosis factor (TNF), IL-1β, IL-2, IL-10 and C-reactive protein, are increased in patients with PD [9,10]. Human studies have shown that a variety of chronic inflammatory diseases including autoimmune rheumatoid arthritis [11], Sjögren syndrome [12], and periodontal inflammatory disease [13] increase the risk of PD development It is not known whether inflammatory bowel disease (IBD) enhances the risk of Parkinson’s disease (PD) or whether PD diagnosis is the result of increased health care use. Corticosteroid and anti-TNF use may prevent PD in patients with IBD

Methods

Results

Conclusion