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Another study finds higher Parkinson’s risk in IBD patients
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Danish patients with inflammatory bowel disease carried a 22% higher risk for developing Parkinson’s disease, according to new research published in Gut.
This follows a similar observational study published just last month in JAMA Neurology that found a 28% increased risk for Parkinson’s among patients with IBD in the U.S.
Investigators from the new Danish nationwide study said their findings support the theory of the gut-brain axis whereby the intestinal environment could influence the central nervous system, and that identifying risk factors for Parkinson’s could guide early interventions to slow progression of the disease.
“Based on more than 80 million person-years of follow-up, we found a significantly increased risk of Parkinson’s disease in IBD patients compared to non-IBD individuals,” Tomasz Brudek, PhD, of the Research Laboratory for Stereology and Neuroscience, Bispebjerg and Frederiksberg Hospital, Copenhagen, told Healio Gastroenterology and Liver Disease. “The increased risk was present in both women and men, across age groups, from first year of IBD diagnosis and throughout 40 years of follow up.”
Given previously drawn connections between Parkinson’s disease and IBD, especially the occurrence of enteric inflammation — IBD’s main symptom — in Parkinson’s, which could be an early indicator of the condition, Brudek and colleagues performed a nationwide population-based cohort study to evaluate this relationship.
“IBD is characterized by chronic pro-inflammatory immune activity, a trait which has gained importance as a fundamental element in neurodegenerative disorders,” Brudek said. “Therefore, intestinal inflammation is of particularly relevance in the pathogenesis of Parkinson’s disease.”
The investigators identified all 76,477 patients diagnosed with IBD in Denmark between 1977 and 2014, and compared them with 7,548,259 controls from the general population without IBD. Throughout the study period, 0.4% of the patients with IBD were diagnosed with Parkinson’s compared with 0.5% of controls, and 0.02% of IBD patients were diagnosed with multiple system atrophy (MSA) compared with 0.01% of controls.
They found a 22% higher risk for Parkinson’s disease among patients with IBD vs. controls (HR = 1.22; 95% CI, 1.09 to 1.35), independent of age at IBD diagnosis, sex or follow-up duration.
While the overall incidence of MSA was low, Brudek and colleagues found that patients with IBD tended to show an increased risk for developing MSA vs. controls (HR=1.41; 95% CI, 0.82-2.44).
Notably, the risk for Parkinson’s was 35% higher among patients with ulcerative colitis (HR=1.35; 95% CI, 1.2-1.52) but not among patients with Crohn’s disease (HR=1.12; 95% CI, 0.89-1.4).
While they noted no firm conclusions about causality can be drawn due to the observational study design, the investigators concluded that their findings show IBD is significantly associated with later development of Parkinson’s disease.
“Although the absolute risk of PD remains low, our study points to overlapping pathogenic mechanisms, which merit further investigation, as they may represent targets for future therapeutic interventions,” they wrote. "The identification of risk factors associated with prodromal phases of Parkinson’s disease may allow for early intervention studies that could modify or slow down disease progress.”
Brudek noted that his team’s results confirm the previous findings reported in JAMA Neurology, but in a larger cohort and with longer follow-up.
“However, the study published by Peter I et al, showed that direct immunomodulatory treatment may be beneficial for Parkinson’s disease patients,” Brudek said. “Our and the recent findings by Peter I et al … contribute to the paradigm shift of considering parkinsonism not just as CNS disorders, but as a group of diseases that may have their onset in the periphery, particularly, the gastrointestinal track. This has important clinical implications and, as we suggest, clinicians should be aware of parkinsonian symptoms in IBD patients.” – by Adam Leitenberger
Disclosures: The authors report no relevant financial disclosures.
Editor's note: This article was updated on May 22 with additional comments from the study author.
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