Parkinson’s Disease Associated With Gastrointestinal Dysfunction

Parkinson’s Disease (PD) is a progressive neurological disease that impairs movement. Gastrointestinal dysfunction is a common symptom associated with the disease of which constipation is one of the common non-motor related complaints that PD patients have. The entire gastrointestinal tract is affected in these patients, causing complications that range from oral issues, including drooling and swallowing problems, to delays in gastric emptying and constipation. Two studies conducted at Aarhus University Hospital, Denmark evaluate the relationship between gastrointestinal (GI) dysfunction and PD. One study correlated actual dysfunction in the GI tract and the subsequent reported constipation. The other study determined the GI regional transit time using a 3D-Transit System.

The study was published in The Journal of Parkinson’s Disease. Elucidating the role of GI tract in the pathological progression of PD hold potential for early diagnosis and treatment.

Parkinson’s Disease (PD)

PD is a progressive neuron degenerating disorder that affects movement and motor skills. It is characterized by a tremor but also causes stiffness and slowing of movement. PD is termed progressive as the symptoms worsen over time. In PD, the neurons in specific part of the brain called substantia nigra are damaged. These neurons produce a chemical called dopamine. When there is deficiency of dopamine abnormal brain activity leads to PD like symptoms.

PD affects less than 1% of the general population, mostly people older than 60 years of age. Even though the average age of onset of symptoms is 60, 5%-10% of patients have symptoms before the age of 40. The prevalence is expected to become three fold in the next 50 years.

Parkinson’s Disease (PD) Signs and Dymptoms

Tremor: A tremor, or shaking, usually begins in a limb, often hand or fingers. A back and forth rubbing of the thumb and forefinger, known as a pill-rolling tremor is common. One characteristic of PD is a tremor of the hand when it is relaxed (at rest).

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Slowed movement: Over time, Parkinson’s disease may reduce one’s ability to move as movements become slow, making simple tasks difficult and time-consuming. Steps may become shorter the feet may drag while walking.

Rigidity: Muscle stiffness may occur in any part of the body, thereby causing pain and limiting motion.

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Impaired posture and balance: Posture may become stooped or bent and one may have balancing problems as a result of Parkinson’s disease.

Gastrointestinal Dysfunction and Parkinson’s Disease

Recent studies have indicated that neuro-degeneration in PD is related to the gut. Gastrointestinal dysfunction symptoms are widely noticed in PD patients, however the underlying pathology is not well explained. Almost any part of the GI tract may be affected causing complications that range from oral issues, including drooling and swallowing problems, to delays in gastric emptying and constipation. Elucidating the role of GI tract in the pathological progression of PD hold potential for early diagnosis and treatment.

Constipation

Constipation is a condition of the digestive system where an individual has hard feces that are difficult to expel. In most cases, this occurs because the colon has absorbed too much water from the food that is in the colon. PD patients are often more troubled with it because the transit of food through the GI tract is slowed. The slower the food moves through the digestive tract, the more water the colon will absorb from it. Consequently, the feces become dry and hard. Relative inactivity also slows down the GI tract.

Evaluating transit time and motility in PD patients and controls

Two studies were conducted by the team; one determined the transit time and the other motility. The study group consisted of 22 early stage PD patients and 15 controls (unaffected normal individuals).

The first study measured actual dysfunction in the colon and compared it to reported constipation. In their study, "Objective Colonic Dysfunction Is Far More Prevalent than Subjective Constipation in Parkinson’s Disease: A Colon Transit and Volume Study," researchers tracked colonic transit time (CTT) (time taken for any particle to travel through the colon) using radio opaque markers. Colonic volume in PD patients was traced via CT scan. They found significantly delayed CTT and increased volume in PD patients.

The second study, "Gastrointestinal Transit Time in Parkinson’s Disease Using a Magnetic Tracking System", used the 3D-Transit system to observe motility in the GI tract. The system tracks the position of an ingested wireless electromagnetic capsule to measure transit times in the GI tract. The results showed that the transit time and colonic motility were increased in PD patients.

The study has also reported for the first time, exact small intestinal transit time (SITT) data in PD patients using the 3D-Transit system. SITT was also increased in PD patients when compared to controls.

The study suggests that there gut problems in PD are under diagnosed when relying solely on subjective symptoms of patients. Researchers claim that while about 40% of PD patients complain of constipation, 80% of them have objective dysfunction in the colon.

While it is accepted that the gut plays a role in PD, better understanding requires similar studies in the area.

References:

1. What is Parkinson’s Disease? - (http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/movement_disorders/conditions/parkinsons_disease.html)
2. Parkinson’s disease - (http://www.mayoclinic.org/diseases-conditions/parkinsons-disease/basics/symptoms/con-20028488)

Source-Medindia