Gastrointestinal Dysfunction in Parkinson’s Disease

Swallowing difficulties and constipation were included in the first description of Parkinsons ́s syndrome from 1817 (Parkinson 1817). Since then, numerous studies have confirmed the magnitude of symptoms and addressed their pathophysiology. In spite of this, much remains to be determined and treatment of gastrointestinal dysfunction in Parkinson ́s disease (PD) is often unsatisfactory. Parkinson ́s disease is now considered a multiorgan syndrome (Den Hartog 1960; Eadie 1963; Ohama and Ikuta 1976) and gastrointestinal dysfunction is one among a number of other complications. Gastrointestinal symptoms affect the quality of life of many patients with PD and altered gastric and small intestinal transit may cause unpredictable absorption of medication further aggravating the classical motor symptoms of PD. The severity of gastrointestinal dysfunction in PD is often closely associated with progression of the disease in general. This makes treatment even more difficult as the patient may be severely handicapped by motor and general autonomic symptoms. In spite of recent progress, the conclusion from the latest Cochrane review on treatment of bowel dysfunction in central neurological diseases still holds true: “Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available“ (Coggrave 2006).