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October 2023
Are specific gut syndromes early warning signs of Parkinson’s disease?
By Melanie Hinze
Early detection of certain gastrointestinal (GI) syndromes might improve the identification of patients at risk of Parkinson’s disease, new research suggests.
Published in Gut, the authors of the multicentre study said it was the first to observe that dysphagia, gastroparesis, constipation and irritable bowel syndrome(IBS) without diarrhoea each increased the risk of a subsequent new onset diagnosis of idiopathic Parkinson’s disease.
In their combined case-control and cohort study using the US nationwide medical record network TriNetX, the authors examined the records of 24,624 patients with idiopathic Parkinson’s disease, 19,046 with Alzheimer’s disease, 23,942 with cerebrovascular disease and 24,624 with none of these conditions. Patients with Parkinson’s disease were matched with those in the other groups for age, sex, race and ethnicity and length of diagnosis to compare the frequency of gut conditions for an average of six years before their Parkinson’s disease diagnosis.
The authors also divided all adults in the network with any of 18 gut conditions into separate groups and matched the people in these groups with people without that specific condition. Participants’ medical records were followed up for five years to assess who developed Parkinson’s disease.
Both analyses found that gastroparesis, dysphagia, IBS without diarrhoea and constipation specifically were associated with an increased risk of a subsequent idiopathic Parkinson’s disease diagnosis.
Functional dyspepsia, IBS with diarrhoea, diarrhoea and faecal incontinence were not specific to a diagnosis Parkinson’s disease, and appendectomy was associated with a decreased risk of Parkinson’s disease.
Distinguished Laureate Professor Nicholas Talley based at the University of Newcastle and Senior Staff Specialist at John Hunter Hospital, Newcastle, said, ‘Twenty years ago, we observed chronic constipation in the community as a strong risk factor for Parkinson’ disease and others reported constipation can precede the onset of idiopathic Parkinson’s disease, suggesting a bowel habit change is in some cases an early nonmotor symptom of this devastating neurodegenerative disease.’
‘The current study in Gut is important because it suggests not only constipation, but also constipation-predominant IBS and gastroparesis (but not functional dyspepsia or diarrhoea) may precede other features of Parkinson’s disease,’ he said.
Professor Talley, who is also NHMRC Leadership Fellow and Chief Investigator at the NHMRC Centre for Research Excellence in Digestive Health, told Medicine Today that it was important to note that most people with IBS, constipation or gastroparesis would never develop Parkinson’s disease.
He said that changes in the intestinal microbiome have been implicated in both disorders of gut-brain interactions such as IBS and Parkinson’s disease. For example, bacteria in animal models are able to induce intestinal alpha-synuclein aggregation, which is the starting point for Parkinson’s disease.
‘In the future, manipulating the intestinal microbiome may offer new hope to slow down or stop progression to Parkinson’s disease,’ Professor Talley said.