Elsevier

The Lancet Neurology

Volume 2, Issue 2, February 2003, Pages 107-116
The Lancet Neurology

Review
Gastrointestinal dysfunction in Parkinson's disease

https://doi.org/10.1016/S1474-4422(03)00307-7Get rights and content

Summary

There is growing recognition that gastrointestinal dysfunction is common in Parkinson's disease (PD). Virtually all parts of the gastrointestinal tract can be affected, in some cases early in the disease course. Weight loss is common but poorly understood in people with PD. Dysphagia can result from dysfunction at the mouth, pharynx, and oesophagus and may predispose individuals to aspiration (accidental inhalation of food or liquid). Gastroparesis can produce various symptoms in patients with PD and may cause erratic absorption of drugs given to treat the disorder. Bowel dysfunction can consist of both slowed colonic transit with consequent reduced bowel-movement frequency, and difficulty with the act of defecation itself with excessive straining and incomplete emptying. Recognition of these gastrointestinal complications can lead to earlier and potentially more effective therapeutic intervention.

Section snippets

Basic mechanisms

Control of gastrointestinal function is complex and involves components of the central, autonomic, and enteric nervous systems. Cortical localisation for some parts of gastrointestinal function, including hunger, vomiting, swallowing, salivation, and defecation, has been identified.13, 14 Subcortical centres, including the basal ganglia, are thought to have some role in the modulation of gastrointestinal function, but exactly where and how is not completely clear. Information from cortical and

Weight loss

Although it is a common feature of PD, unintended weight loss has received little direct study. Abbott and colleagues26 documented weight loss in 52% of individuals with PD, with 22% losing over 12·8 kg. Beyer and colleagues reported a mean weight loss of 3·3 kg in 51 patients with PD, compared with a weight gain of about 1 kg in 49 control individuals.27 PD patients were four times more likely than controls to report a weight loss of more than 4·5 kg. Differences between men and women in

Conclusion

Gastrointestinal dysfunction in PD can manifest in many ways and pose many problems. Gastrointestinal features of PD occur along the whole tract and at any stage of the illness. Awareness of the various gastrointestinal manifestations of PD can facilitate prompt recognition and effective treatment of these potentially distressing symptoms.

Search strategy and selection criteria

Data for this review were identified from my personal files, textbooks, and from PubMed searches with the terms “gastrointestinal dysfunction”, “weight loss”, “dysphagia”, “gastroparesis”, “gastric emptying”, “small intestine”, “colon”, and “anorectal” coupled with the term “Parkinson's disease”. Articles written in English were primarily and preferentially used, although a few articles in other languages were also included when an English abstract was present.

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