Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, United Kingdom.
Mov Disord. 2014 Jan;29(1):23-32. doi: 10.1002/mds.25708. Epub 2013 Oct 21.
Gastrointestinal symptoms are evident in all stages of Parkinson's disease (PD). Most of the gastrointestinal abnormalities associated with PD are attributable to impaired motility. At the level of the stomach, this results in delayed gastric emptying. The etiology of delayed gastric emptying in PD is probably multifactorial but is at least partly related to Lewy pathology in the enteric nervous system and discrete brainstem nuclei. Delayed gastric emptying occurs in both early and advanced PD but is underdetected in routine clinical practice. Recognition of delayed gastric emptying is important because it can cause an array of upper gastrointestinal symptoms, but additionally it has important implications for the absorption and action of levodopa. Delayed gastric emptying contributes significantly to response fluctuations seen in people on long-term l-dopa therapy. Neurohormonal aspects of the brain-gut axis are pertinent to discussions regarding the pathophysiology of delayed gastric emptying in PD and are also hypothesized to contribute to the pathogenesis of PD itself. Ghrelin is a gastric-derived hormone with potential as a therapeutic agent for delayed gastric emptying and also as a novel neuroprotective agent in PD. Recent findings relating to ghrelin in the context of PD and gastric emptying are considered. This article highlights the pathological abnormalities that may account for delayed gastric emptying in PD. It also considers the wider relevance of abnormal gastric pathology to our current understanding of the etiology of PD.
胃肠道症状在帕金森病（PD）的所有阶段都很明显。与 PD 相关的大多数胃肠道异常都归因于运动障碍。在胃部水平，这导致胃排空延迟。PD 中胃排空延迟的病因可能是多因素的，但至少部分与肠神经系统和离散脑干核中的路易体病理学有关。胃排空延迟在早期和晚期 PD 中均会发生，但在常规临床实践中检测不足。识别胃排空延迟很重要，因为它会引起一系列上胃肠道症状，但它对左旋多巴的吸收和作用也有重要影响。胃排空延迟对长期接受 l-多巴治疗的患者中出现的反应波动有重要贡献。脑-肠轴的神经激素方面与讨论 PD 中胃排空延迟的病理生理学有关，并且也被假设为 PD 本身的发病机制的一部分。胃饥饿素是一种胃来源的激素，具有作为胃排空延迟治疗剂的潜力，并且也是 PD 中的新型神经保护剂。考虑了与 PD 和胃排空相关的胃饥饿素的最新发现。本文强调了可能导致 PD 中胃排空延迟的病理性异常。它还考虑了异常胃病理学对我们目前对 PD 病因的理解的更广泛相关性。
