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Gastrointestinal Dysfunction in Parkinson’s Disease

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Abstract

There has been exponential growth in the awareness and understanding of gastrointestinal (GI) dysfunction in Parkinson’s disease (PD) over the past 3 decades. The clinical features of GI dysfunction in PD have been clearly identified and innovative research has demonstrated the presence of pathology within the enteric nervous system (ENS) in individuals with PD, leading to suggestions that the GI system may be ground zero for the genesis and the portal of entry of PD pathology, which then ascends via the vagus nerve to the central nervous system (CNS). This theory, as well as the more recent recognition of the association of PD with dysbiosis within the gut microbiota, has been the object of intense study and scrutiny. Since most PD medications are absorbed through the GI system, the need for better understanding of changes within the GI tract that may potentially affect the pattern of response to medications has become evident. In this review, current knowledge of the pathophysiology of changes within the GI tract and the gut microbiome of individuals with PD, including changes that occur with progression of the disease, will be addressed. We focus on common clinical GI problems in PD that can arise from different segments of the GI tract. Relevant diagnostic evaluations and treatment options for each of these problems will be reviewed.

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  1. Department of Neurology, Oregon Health & Science University, Portland, OR, USA

    Delaram Safarpour & Ronald F. Pfeiffer

  2. Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, OR, USA

    Kaveh Sharzehi

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Kaveh Sharzehi reports no conflicts of interest. Delaram Safarpour has received compensation for advisory board participation from Abbvie and Boston Scientific; consultation fees from Abbott; and institutional grant support from the Parkinson Study Group. Ronald F. Pfeiffer is a member of the Data Safety Monitoring Board of Enterin Inc; Programmatic Panel Member of the Neurotoxin Exposure Treatment Parkinson’s Program, Congressionally Directed Medical Research Programs, Department of Defense; and receives royalties for books edited from CRC Press and Humana Press; podcast participation for Acorda; legal consulting for Henry & Beaver, LLP.

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Safarpour, D., Sharzehi, K. & Pfeiffer, R.F. Gastrointestinal Dysfunction in Parkinson’s Disease. Drugs 82, 169–197 (2022). https://doi.org/10.1007/s40265-021-01664-1

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