Gastrointestinal (GI) symptoms are commonly experienced by patients with PD, particularly difficulties with swallowing (dysphagia), drooling, and constipation.1
Drooling, where saliva is involuntarily lost from the mouth, is an embarrassing problem with a severe impact on social functioning.9 It affects approximately half of all patients with PD, but may be managed with the use of behavioural techniques, and with training from a speech therapist who will help the patient to swallow.9
Constipation is often evident several years, or even decades, prior to the onset of motor symptoms.1 The pathological mechanisms behind constipation in PD remain unclear, however, although there is some evidence of greater α-synuclein accumulation in the colons of patients with PD.10 Some medications used to treat PD, particularly anticholinergics and dopamine agonists, may increase the likelihood of suffering from constipation, but there is also likely to be a loss of GI function caused by the disease process itself.1,11
Standard treatment options include: a high-fibre diet (including psyllium supplements), increased fluid intake, the use of laxatives, and neuromuscular training in the form of ‘biofeedback therapy’.1,11
References:
1. Fasano A, Visanji NP, Liu LW, et al. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2015; 14 (6): 625–639.
2. Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. Curr Treat Options Neurol 2018; 20 (12): 54.
3. Todorova A, Jenner P, Ray Chaudhuri K. Non-motor Parkinson’s: integral to motor Parkinson’s, yet often neglected. Pract Neurol 2014; 14 (5): 310–322.
4. Knudsen K, Fedorova TD, Bekker AC, et al. Objective colonic dysfunction is far more prevalent than subjective constipation in Parkinson’s disease: a colon transit and volume study. J Parkinsons Dis 2017; 7 (2): 359–367.
5. Tan AH, Chuah KH, Beh YY, Schee JP, Mahadeva S, Lim SY. Gastrointestinal dysfunction in Parkinson’s disease: neurogastroenterology perspectives on a multifaceted problem. J Mov Disord 2023; 16 (2): 138–151.
6. Adams-Carr KL, Bestwick JP, Shribman S, et al. Constipation preceding Parkinson’s disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87 (7): 710–716.
7. Schrag A, Bohlken J, Dammertz L, et al. Widening the spectrum of risk factors, comorbidities, and prodromal features of Parkinson disease. JAMA Neurol 2023; 80 (2): 161–171.
8. Knudsen K, Krogh K, Østergaard K, Borghammer P. Constipation in Parkinson’s disease: subjective symptoms, objective markers, and new perspectives. Mov Disord 2017; 32 (1): 94–105.
9. Kalf JG, de Swart BJ, Borm GF, et al. Prevalence and definition of drooling in Parkinson’s disease: a systematic review. J Neurol 2009; 256 (9): 1391–1396.
10. Lebouvier T, Chaumette T, Damier P, et al. Pathological lesions in colonic biopsies during Parkinson’s disease. Gut 2008; 57: 1741–1743.
11. Mukherjee A, Biswas A, Das SK. Gut dysfunction in Parkinson’s disease. World J Gastroenterol 2016; 22 (25): 5742–5752.
