by Kristina Fiore Associate Editor, MedPage TodayJune 22, 2016
BERLIN -- Irritable bowel syndrome
may be a more frequent symptom in Parkinson's disease than constipation,
researchers reported here.
In a case-control study, about a
quarter of Parkinson's patients had IBS compared with only 5% of healthy
controls (P=0.001), according to Tuomas
Mertsalmi, MD, of the University of Helsinki, and colleagues.
On the other hand, the prevalence of constipation was
higher among Parkinson's patients, but the difference from healthy controls
wasn't significant, they reported at the Movement Disorders Society meeting here.
"Gastrointestinal symptoms in
Parkinson's disease are more complex than just constipation," Mertsalmi
told MedPage Today. "Usually constipation is just seen as decrease
bowel frequency, but it is also about straining during defecation, hard and
lumpy stools, and diarrhea in these patients."
Previous work has shown that the
majority of patients with Parkinson's suffer from gastrointestinal symptoms.
About 70% have been estimated to have constipation, which is considered to be a
premotor symptom of the disease and is one of the strongest risk factors for
Parkinson's, Mertsalmi said.
IBS is among the most common
functional gastrointestinal disorders, and is characterized by symptoms of
abdominal pain or discomfort, and alteration of bowel habits.
Mertsalmi and colleagues suspected
that some constipated Parkinson's patients might instead have a more
complicated spectrum of bowel problems, particularly IBS. So they conducted a
case-control study comparing 74 Parkinson's patients with 75 sex- and
age-matched controls without the disease and without any symptoms of
Parkinson's.
All patient with a pre-existing
diagnosis of IBS were excluded, he added.
They examined four types of IBS:
with constipation, diarrhea-dominant, mixed with both constipation and
diarrhea, and unsubtyped.
Overall, they found IBS was
significantly more prevalent in Parkinson's patients than in controls (24.3%
versus 5.3%, P=0.001) -- but rates of constipation weren't significantly
different between groups (12.2% versus 4%, P=0.072).
The two most common subtypes in
Parkinson's patients were mixed IBS (14.9%) and constipation-predominant
(6.8%), they reported.
Parkinson's patients with IBS also
had a higher prevalence of other non-motor symptoms than Parkinson' patients
without IBS, but there was no difference between groups in terms of motor
symptoms, Mertsalmi said.
When they looked at gut bacteria,
they found a lower prevalence of Prevotella bacteria in IBS patients
than in those without IBS, but Mertsalmi warned that their study can't
determine the nature of the association.
He concluded that IBS, especially
the IBS-mixed subtype, is common in Parkinson's patients, and that these
patients may suffer from a broader spectrum of distal gastrointestinal symptoms
in addition to constipation.
Peter Schmidt, PhD, of
the National Parkinson's Foundation, who wasn't involved in the study, said
it's important for physicians to understand the manifestations of constipation
in Parkinson's disease.
"Gastrointestinal issues are
a common cause of hospitalization, and when Parkinson's patients are admitted
to the hospital for constipation their medications may be changed in a way
their neurologist isn't aware of, and that can be detrimental to their
Parkinson's symptoms."
"Anything we can do to keep
patients out of the hospital is valuable," he said. "Addressing
something that's an important acute symptom but not always recognized as part
of Parkinson's care is valuable."
http://www.medpagetoday.com/MeetingCoverage/MDS/58693?xid=NL_breakingnews_2016-06-22&eun=g972365d0r
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