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Ramu SK, Oblizajek NR, Savica R, Chunawala ZS, Deb B, Bharucha AE. Defecatory disorders are a common cause of chronic constipation in Parkinson disease. Neurogastroenterol Motil 2024; 36:e14767. [PMID: 38376243 PMCID: PMC11061800 DOI: 10.1111/nmo.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND AIMS Up to 50% of patients with Parkinson disease have constipation (PD-C), but the prevalence of defecatory disorders caused by rectoanal dyscoordination in PD-C is unknown. We aimed to compare anorectal function of patients with PD-C versus idiopathic chronic constipation (CC). METHODS Anorectal pressures, rectal sensation, and rectal balloon expulsion time (BET) were measured with high-resolution anorectal manometry (HR-ARM) in patients with PD-C and control patients with CC, matched for age and sex. RESULTS We identified 97 patients with PD-C and 173 control patients. Eighty-six patients with PD-C (89%) had early PD, and 39 (40%) had a defecatory disorder, manifest by a prolonged rectal balloon expulsion time (37 patients) or a lower rectoanal pressure difference during evacuation (2 patients). PD-C patients with a prolonged BET had a greater anal resting pressure (p = 0.02), a lower rectal pressure increment (p = 0.005), greater anal pressure (p = 0.047), and a lower rectoanal pressure difference during evacuation (p < 0.001). Rectal sensory thresholds were greater in patients with abnormal BET. In the multivariate model comparing CC and PD-C (AUROC = 0.76), PD-C was associated with a lower anal squeeze increment (odds ratio [OR] for PD-C, 0.93 [95% CI, 0.91-0.95]), longer squeeze duration (OR, 1.05 [95% CI, 1.03-1.08]), lower rectal pressure increment (OR per 10 mm Hg, 0.72 [95% CI, 0.66-0.79]), and negative rectoanal gradient during evacuation (OR per 10 mm Hg, 1.16 [95% CI, 1.08-1.26]). CONCLUSIONS Compared with CC, PD-C was characterized by impaired squeeze pressure, longer squeeze duration, lower increase in rectal pressure, and a more negative rectoanal gradient during evacuation.
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Affiliation(s)
| | - Nicholas R Oblizajek
- Division of Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Rodolfo Savica
- Division of Movement Disorders, Mayo Clinic, Rochester, Minnesota, USA
| | - Zainali S Chunawala
- Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Brototo Deb
- Research Fellow in the Enteric Neuroscience Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Adil E Bharucha
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
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Pasricha TS, Guerrero-Lopez IL, Kuo B. Management of Gastrointestinal Symptoms in Parkinson's Disease: A Comprehensive Review of Clinical Presentation, Workup, and Treatment. J Clin Gastroenterol 2024; 58:211-220. [PMID: 38260966 PMCID: PMC10855995 DOI: 10.1097/mcg.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
Gastrointestinal symptoms in Parkinson's disease (PD) are among the most prevalent and debilitating of complications and present unique diagnostic and management challenges. Patients with PD commonly experience dysphagia, nausea, bloating, and constipation related to pathologic involvement of the enteric nervous system. In turn, gastrointestinal complications may impact motor fluctuations and the efficacy of levodopa therapy. This review will explore the common gastrointestinal manifestations of PD with an emphasis on clinical presentation, workup, and treatment strategies.
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Affiliation(s)
- Trisha S. Pasricha
- Division of Gastroenterology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
| | | | - Braden Kuo
- Division of Gastroenterology, Massachusetts General Hospital
- Harvard Medical School, Boston, MA
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Mawe GM, Sanders KM, Camilleri M. Overview of the Enteric Nervous System. Semin Neurol 2023; 43:495-505. [PMID: 37562453 DOI: 10.1055/s-0043-1771466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Propulsion of contents in the gastrointestinal tract requires coordinated functions of the extrinsic nerves to the gut from the brain and spinal cord, as well as the neuromuscular apparatus within the gut. The latter includes excitatory and inhibitory neurons, pacemaker cells such as the interstitial cells of Cajal and fibroblast-like cells, and smooth muscle cells. Coordination between these extrinsic and enteric neurons results in propulsive functions which include peristaltic reflexes, migrating motor complexes in the small intestine which serve as the housekeeper propelling to the colon the residual content after digestion, and mass movements in the colon which lead to defecation.
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Affiliation(s)
- Gary M Mawe
- Department of Neurological Sciences, The University of Vermont, Burlington, Vermont
| | - Kenton M Sanders
- Department of Physiology and Cell Biology, University of Nevada, Reno, School of Medicine, Reno, Nevada
| | - Michael Camilleri
- Division of Gastroenterology and Hepatology, Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic, Rochester, Minnesota
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Yan Y, Shimoga D, Sharma A. Parkinson's Disease and Diabetes Mellitus: Synergistic Effects on Pathophysiology and GI Motility. Curr Gastroenterol Rep 2023; 25:106-113. [PMID: 37067721 DOI: 10.1007/s11894-023-00868-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE OF REVIEW Parkinson's disease and diabetes affect an increasing proportion of the aging global population. Both conditions extensively affect gastrointestinal (GI) motility with similar and differing clinical symptoms. Nonetheless, GI symptoms in Parkinson's disease and diabetes pose significant morbidity and impairment of quality of life. Their pathophysiology is poorly understood, and therefore, effective treatment options are lacking. RECENT FINDINGS Parkinson's disease patients have oropharyngeal dysphagia and constipation. They also have mild or absent upper GI symptoms associated with delayed gastric emptying, which is prevalent in 70% of patients. Delayed gastric emptying in Parkinson's disease leads to erratic medication absorption and fluctuating motor symptoms. Half of diabetics have upper GI symptoms, which correlate to gastric emptying and changes in brain activity of the insular cortex. The majority of diabetics also have constipation. Diabetics have an increased risk for developing Parkinson's disease and anti-diabetic medications are associated with risk reduction of developing Parkinson's disease. Hyperglycemia is associated with advanced glycated end products formation and acceleration of α-synuclein aggregation. GLP-1 receptor agonists have also demonstrated efficacy in improving motor symptoms and cognition in Parkinson's disease patients with diabetes. Parkinson's disease and diabetes are pan-enteric disorders with significant GI symptoms and impairment of gut motility. Both conditions have synergistic pathophysiologies that propagate neurodegenerative changes. Treatment options for GI symptoms in diabetic and Parkinson's disease patients are lacking. Anti-diabetic treatment improves motor symptoms in Parkinson's disease, however, its effect on GI symptoms is unclear.
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Affiliation(s)
- Yun Yan
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA
| | - Dhanush Shimoga
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA
| | - Amol Sharma
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical College of Georgia, Augusta University, 1120 15th Street, AD 2226, Augusta, GA, 30912, USA.
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Wang J, Cao Y, Hou W, Bi D, Yin F, Gao Y, Huang D, Li Y, Cao Z, Yan Y, Zhao J, Kong D, Lv X, Huang L, Zhong H, Wu C, Chen Q, Yang R, Wei Q, Qin H. Fecal microbiota transplantation improves VPA-induced ASD mice by modulating the serotonergic and glutamatergic synapse signaling pathways. Transl Psychiatry 2023; 13:17. [PMID: 36670104 PMCID: PMC9859809 DOI: 10.1038/s41398-023-02307-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
Autism spectrum disorder (ASD) is a complex behavioral disorder diagnosed by social interaction difficulties, restricted verbal communication, and repetitive behaviors. Fecal microbiota transplantation (FMT) is a safe and efficient strategy to adjust gut microbiota dysbiosis and improve ASD-related behavioral symptoms, but its regulatory mechanism is unknown. The impact of the microbiota and its functions on ASD development is urgently being investigated to develop new therapeutic strategies for ASD. We reconstituted the gut microbiota of a valproic acid (VPA)-induced autism mouse model through FMT and found that ASD is in part driven by specific gut dysbiosis and metabolite changes that are involved in the signaling of serotonergic synapse and glutamatergic synapse pathways, which might be associated with behavioral changes. Further analysis of the microbiota showed a profound decrease in the genera Bacteroides and Odoribacter, both of which likely contributed to the regulation of serotonergic and glutamatergic synapse metabolism in mice. The engraftment of Turicibacter and Alistipes was also positively correlated with the improvement in behavior after FMT. Our results suggested that successful transfer of the gut microbiota from healthy donors to ASD mice was sufficient to improve ASD-related behaviors. Modulation of gut dysbiosis by FMT could be an effective approach to improve ASD-related behaviors in patients.
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Affiliation(s)
- Jifeng Wang
- grid.412538.90000 0004 0527 0050Department of Pathology, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Yuan Cao
- grid.412538.90000 0004 0527 0050Department of Pathology, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Weiliang Hou
- grid.412538.90000 0004 0527 0050Intestinal Microenvironment Treatment Center, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Dexi Bi
- grid.412538.90000 0004 0527 0050Department of Pathology, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Fang Yin
- grid.412538.90000 0004 0527 0050Intestinal Microenvironment Treatment Center, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Yaohui Gao
- grid.412538.90000 0004 0527 0050Department of Pathology, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Dengfeng Huang
- grid.412538.90000 0004 0527 0050Department of Pathology, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Yingying Li
- grid.412538.90000 0004 0527 0050Department of Pathology, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Zhan Cao
- grid.412538.90000 0004 0527 0050Intestinal Microenvironment Treatment Center, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Yinmei Yan
- grid.412538.90000 0004 0527 0050Department of Pediatrics, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Jianhua Zhao
- Shanghai Majorbio Bio-pharm Technology Co.,Ltd, 201210 Shanghai, China
| | - Dewu Kong
- Shanghai Majorbio Bio-pharm Technology Co.,Ltd, 201210 Shanghai, China
| | - Xiaoqiong Lv
- grid.412538.90000 0004 0527 0050Intestinal Microenvironment Treatment Center, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Linsheng Huang
- grid.412538.90000 0004 0527 0050Department of Pediatrics, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Hui Zhong
- grid.412538.90000 0004 0527 0050Department of Pediatrics, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Chunyan Wu
- grid.412538.90000 0004 0527 0050Intestinal Microenvironment Treatment Center, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Qiyi Chen
- grid.412538.90000 0004 0527 0050Intestinal Microenvironment Treatment Center, Shanghai Tenth People’s Hospital Affiliated to Tongji University, 200072 Shanghai, China
| | - Rong Yang
- Department of Pediatrics, Shanghai Tenth People's Hospital Affiliated to Tongji University, 200072, Shanghai, China.
| | - Qing Wei
- Department of Pathology, Shanghai Tenth People's Hospital Affiliated to Tongji University, 200072, Shanghai, China.
| | - Huanlong Qin
- Intestinal Microenvironment Treatment Center, Shanghai Tenth People's Hospital Affiliated to Tongji University, Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital Affiliated to Tongji University, 200072, Shanghai, China.
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Gao Y, Cheng Y, Chen J, Lin D, Liu C, Zhang LK, Yin L, Yang R, Guan YQ. NIR-Assisted MgO-Based Polydopamine Nanoparticles for Targeted Treatment of Parkinson's Disease through the Blood-Brain Barrier. Adv Healthc Mater 2022; 11:e2201655. [PMID: 36153843 DOI: 10.1002/adhm.202201655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/20/2022] [Indexed: 01/28/2023]
Abstract
The blood-brain barrier (BBB) is a major limiting factor that prevents the treatment of Parkinson's disease (PD). In the present study, MgOp@PPLP nanoparticles are explored by using MgO nanoparticles as a substrate, polydopamine as a shell, wrapping anti-SNCA plasmid inside, and modifying polyethylene glycol, lactoferrin, and puerarin on the surface to improve the hydrophilicity, brain targeting and antioxidant properties of the particles, respectively. MgOp@PPLP exhibits superior near-infrared radiation (NIR) response. Under the guidance of photothermal effect, these MgOp@PPLP particles are capable of penetrating the BBB and be taken up by neuronal cells to exert gene therapy and antioxidant therapy. In both in vivo and in vitro models of PD, MgOp@PPLP exhibits good neuroprotective effects. Therefore, combined with noninvasive NIR radiation, MgOp@PPLP nanoplatform with good biocompatibility becomes an ideal material to combat neurodegenerative diseases.
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Affiliation(s)
- Yifei Gao
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Yuxue Cheng
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Jiapeng Chen
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Danmin Lin
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Chao Liu
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Ling-Kun Zhang
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Liang Yin
- School of Life Science, South China Normal University, Guangzhou, 510631, China
| | - Runcai Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, 510060, China
| | - Yan-Qing Guan
- School of Life Science, South China Normal University, Guangzhou, 510631, China.,Guangzhou Key Laboratory of Spectral Analysis and Functional Probes, College of Biophotonics, South China Normal University, Guangzhou, 510631, China.,South China Normal University-Panyu Central Hospital Joint Laboratory of Translational Medical Research, Panyu Central Hospital, Guangzhou, 511400, China
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