Parkinson’s patients often have GI dysfunction without constipation symptoms

A pair of studies published in the Journal of Parkinson’s Disease shed light on the burden of constipation and GI dysfunction in patients with Parkinson’s disease.

In the first, researchers found that objective colonic dysfunction was “considerably more prevalent” than subjective constipation in patients with Parkinson’s disease (PD).

“In the present study, 79% of early-stage PD patients had significantly increased [colonic transit time (CTT)] and 66% showed increased colonic volume,” Per Borghammer, MD, PhD, DMSc, of the department of clinical medicine and the Positron Emission Tomography Center at Aarhus University in Denmark, said in a press release. “The difference in CTT was more pronounced in the transverse, descending, and rectosigmoid segments of the colon, indicating that early stage PD patients exhibit a combination of slow transit and outlet constipation.”

To compare PD patients’ actual colonic function vs. their subjective constipation reports, Borghammer and colleagues measured CTT, colonic volume and gastric emptying in 32 patients with PD and 26 controls who also reported subjective GI symptoms via three questionnaires.

In addition to the 79% with increased CTT (P < .0001) and the 66% with increased colonic volume (P = .0002), they found patients with PD showed the same rate of gastric emptying as controls, and that few patients with PD showed signs of medication malabsorption.

“These negative findings go against the commonly held notion that slowed gastric emptying and malabsorption of medication is a common problem in early stage PD,” Borghammer said in the press release. “However, at later disease stages it may be another matter.”

The investigators also found that patients with PD showed a significantly lower prevalence of subjective constipation compared with objective dysfunction, which varied widely from 3% to 38% depending on whether the Rome III, NMSQuest or Cleveland constipation scores were used.

“These findings highlight the need for more research on how to define constipation in PD and also the need for improved understanding of the relationship between subjective symptoms and objective dysfunction,” Borghammer said.

Given the variability of patients’ subjective constipation reports, Borghammer and colleagues also conducted a second study in which they evaluated objective data on GI transit times using the 3D-Transit System (Motilis Medica SA), an ingested wireless electromagnetic capsule, in 22 patients with PD and 15 controls over a 24-hour period.

They found that that patients with PD showed significant differences in their transit times and colonic motility patterns.

“Using the ambulatory 3D-Transit system we report exact small intestinal transit time (SITT) data in PD for the first time,” Borghammer said. “The SITT was significantly increased compared to control subjects. We also demonstrated a highly significant increase in proximal colonic transit time, and a decrease in colonic mass- and fast movements in the PD patients.”

They showed that GI dysfunction was more widespread in patients with PD than previously thought, with delayed transit times affecting the small intestine in addition to the colon.

“This dysfunction appears to gradually increase from the proximal to the distal part of the GI tract,” according to the press release.

The investigators concluded that future research is needed to better understand the important relationship between PD and GI function.

“Our studies suggest that gut problems are markedly under-diagnosed when relying solely on the subjective symptoms of the patients,” Borghammer concluded. “In short, about 40% of PD patients complain of constipation but up to 80% have objective dysfunction of the colon.” – by Adam Leitenberger

References:

Knudsen K, et al. J Parkinsons Dis. 2017;doi:10.3233/JPD-171131.

Knudsen K, et al. J Parkinsons Dis. 2017;doi:10.3233/JPD-161050.

Disclosures: Borghammer reports he is a consultant for F. Hoffman-La Roche. Please see the full studies for a list of all other researchers’ relevant financial disclosures.