title: Nonmotor gastrointestinal disorders in older patients with Parkinson's disease: is there hope?
abstract: Despite the fact that nonmotor symptoms (NMS) like gastrointestinal (GI) complaints are frequently reported in Parkinson's disease (PD), no therapeutic guidelines are available. This study aimed to manage some lower GI-NMS in a group of patients with PD. A total of 40 patients (17 males, 23 females; mean age 76.05±2.09 years) were randomly selected for this study. Patients were confirmed to have PD (modified Hoehn-Yars scale: 2.075±0.4) who had undergone levodopa or dopamine agonist treatment. In the non-motor symptoms questionnaire (NMS-Quest), regarding GI complaints, the following were recorded: abdominal pain, bloating, and constipation of mild-to-moderate severity. Laboratory studies, abdominal ultrasound, and upper and lower digestive endoscopies were performed to rule out organic issues. All patients increased their water intake to 2 L/d and alimentary fiber to 20-25 g/d. Twenty patients received trimebutine 200 mg three times daily half an hour before meals. The other 20 patients received probiotics (60 mg per-tablet of two lactic bacteria:Lactobacillus acidophilusandBifidobacterium infantis), 2×/d, 1 hour after meals for 3 months along with the reassessment of GI complaints. Our results demonstrated that there were significant statistical differences in all assessed symptoms in the first group: 1.55±0.51 vs 0.6±0.5 (P<0.0001) for abdominal pain; 1.6±0.5 vs 0.45±0.51 (P<0.0001) for bloating; and 1.5±0.51 vs 0.85±0.67 (P=0.0014) for constipation with incomplete defecation. The second group displayed statistical differences only for abdominal pain 1.45±0.51 vs 1.05±0.69 (P=0.00432) and bloating 1.4±0.5 vs 0.3±0.47 (P<0.0001). For constipation with incomplete defecation, there was a slight improvement. Thus, there was no significant statistical difference: 1.35±0.49 vs 1.15±0.49 (P=0.2040). In conclusion, lower GI-NMS are frequently present, isolated or associated with other autonomic issues, even before the diagnosis of PD. Treatment with probiotics could improve abdominal pain and bloating as much as with trimebutine, but less for constipation with incomplete evacuation, where trimebutine showed better results.
authors.affiliation: Department of Internal Medicine.
authors.forename: Doina
authors.initials: D
authors.lastname: Georgescu
authors.affiliation: Department of Internal Medicine.
authors.forename: Oana Elena
authors.initials: OE
authors.lastname: Ancusa
authors.affiliation: Department of Urology.
authors.forename: Liviu Andrei
authors.initials: LA
authors.lastname: Georgescu
authors.affiliation: Department of Hematology.
authors.forename: Ioana
authors.initials: I
authors.lastname: Ionita
authors.affiliation: Department of Neurology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Reisz
mesh_terms: D000367:Age Factors; D000368:Aged; D001644:Bifidobacterium; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000178:diet therapy / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007779:Lactobacillus acidophilus; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy / Q000503:physiopathology*; D019936:Probiotics / Q000627:therapeutic use*; D014287:Trimebutine / Q000627:therapeutic use*
chemical_list: D005765:Gastrointestinal Agents; D014287:Trimebutine
keywords: PD; lower GI-NMS; probiotics; prokinetics; trimebutine