Search

Different gastrointestinal symptoms, such as excessive salivation, deterioration and other disorders affecting the teeth, dysphagia, gastroparesis, gastroesophageal reflux, constipation, difficult defecation or loss of weight are frequent events in all the stages of the development of Parkinson's disease and affect at least a third of the patients. These symptoms reflect the dysfunction of the enteric nervous system, and the stomach is one of the organs where alpha-synuclein is first deposited. Other factors, such as the dysfunction of structures in the central nervous system like the dorsal motor nucleus of the vagal nerve, hormonal factors or secondary effects deriving from the consumption of antiparkinsonian drugs, are involved in its origin. The present article offers a detailed review of the epidemiological, pathophysiological, clinical and therapeutic management aspects of the different gastrointestinal symptoms in Parkinson's disease.Gastroparesia y otros sintomas gastrointestinales en la enfermedad de Parkinson.Diferentes sintomas gastrointestinales, como salivacion excesiva, deterioro y otros trastornos de las piezas dentarias, disfagia, gastroparesia, reflujo gastroesofagico, estreñimiento, dificultades en la defecacion o perdida de peso, son frecuentes en todos los estadios evolutivos de la enfermedad de Parkinson y afectan al menos a un tercio de los pacientes. Estos sintomas reflejan la disfuncion del sistema nervioso enterico, siendo el estomago uno de los organos donde mas precozmente se deposita la alfa-sinucleina. Otros factores, como la disfuncion de estructuras del sistema nervioso central como el nucleo motor dorsal del nervio vago, factores hormonales o efectos secundarios derivados del consumo de farmacos antiparkinsonianos estan implicados en su origen. El presente articulo revisa en detalle aspectos epidemiologicos, fisiopatologicos, clinicos y de manejo terapeutico de los diferentes sintomas gastrointestinales en la enfermedad de Parkinson.

Objective: The aim of the present study was to analyze the progression of non-motor symptoms (NMS) burden in Parkinson's disease (PD) patients regarding the development of motor fluctuations (MF). Methods: PD patients without MF at baseline, who were recruited from January 2016 to November 2017 (V0) and evaluated again at a 2-year follow-up (V2) from 35 centers of Spain from the COPPADIS cohort, were included in this analysis. MF development at V2 was defined as a score >= 1 in the item-39 of the UPDRS-Part IV, whereas NMS burden was defined according to the Non-motor Symptoms Scale (NMSS) total score. Results: Three hundred and thirty PD patients (62.67 +/- 8.7 years old; 58.8% males) were included. From V0 to V2, 27.6% of the patients developed MF. The mean NMSS total score at baseline was higher in those patients who developed MF after the 2-year follow-up (46.34 +/- 36.48 vs. 34.3 +/- 29.07; p = 0.001). A greater increase in the NMSS total score from V0 to V2 was observed in patients who developed MF (+16.07 +/- 37.37) compared to those who did not develop MF (+6.2 +/- 25.8) (p = 0.021). Development of MF after a 2-year follow-up was associated with an increase in the NMSS total score (beta = 0.128; p = 0.046) after adjustment to age, gender, years from symptoms onset, levodopa equivalent daily dose (LEDD) and the NMSS total score at baseline, and the change in LEDD from V0 to V2. Conclusions: In PD patients, the development of MF is associated with a greater increase in the NMS burden after a 2-year follow-up.