Poirier Andrée-Anne, Aubé Benoit, Côté Mélissa, Morin Nicolas, Di Paolo Thérèse, Soulet Denis
Axe Neurosciences, Centre de Recherche du CHU de Québec (Pavillon CHUL), Quebec City, QC, Canada; Faculty of Pharmacy, Laval University, Quebec City, QC, Canada.
Axe Neurosciences, Centre de Recherche du CHU de Québec (Pavillon CHUL), Quebec City, QC, Canada.
Parkinsons Dis. 2016;2016:6762528. doi: 10.1155/2016/6762528. Epub 2016 Dec 6.
A diagnosis of Parkinson's disease is classically established after the manifestation of motor symptoms such as rigidity, bradykinesia, and tremor. However, a growing body of evidence supports the hypothesis that nonmotor symptoms, especially gastrointestinal dysfunctions, could be considered as early biomarkers since they are ubiquitously found among confirmed patients and occur much earlier than their motor manifestations. According to Braak's hypothesis, the disease is postulated to originate in the intestine and then spread to the brain via the vagus nerve, a phenomenon that would involve other neuronal types than the well-established dopaminergic population. It has therefore been proposed that peripheral nondopaminergic impairments might precede the alteration of dopaminergic neurons in the central nervous system and, ultimately, the emergence of motor symptoms. Considering the growing interest in the gut-brain axis in Parkinson's disease, this review aims at providing a comprehensive picture of the multiple gastrointestinal features of the disease, along with the therapeutic approaches used to reduce their burden. Moreover, we highlight the importance of gastrointestinal symptoms with respect to the patients' responses towards medical treatments and discuss the various possible adverse interactions that can potentially occur, which are still poorly understood.
帕金森病的诊断通常在出现运动症状如僵硬、运动迟缓及震颤后确立。然而，越来越多的证据支持这样一种假说，即非运动症状，尤其是胃肠功能障碍，可被视为早期生物标志物，因为在确诊患者中普遍存在，且比运动症状出现得早得多。根据布拉克假说，该疾病被认为起源于肠道，然后通过迷走神经扩散至大脑，这一现象涉及的神经元类型不同于已明确的多巴胺能神经元群体。因此，有人提出外周非多巴胺能损伤可能先于中枢神经系统多巴胺能神经元的改变，最终导致运动症状的出现。鉴于对帕金森病中肠-脑轴的兴趣日益浓厚，本综述旨在全面呈现该疾病的多种胃肠道特征，以及用于减轻其负担的治疗方法。此外，我们强调胃肠道症状对患者药物治疗反应的重要性，并讨论各种可能发生的不良相互作用，而这些相互作用仍了解甚少。
