Subtle Esophageal Motility Alterations in Parkinsonian Syndromes: Synucleinopathies vs. Tauopathies.

BACKGROUND

Esophageal dysfunction is a frequent phenomenon in Parkinson's disease during all disease stages, but data about esophageal involvement in atypical parkinsonian syndromes as well as possible differences between alpha-synucleinopathies and tauopathies, including causative links to the origin of the dysfunction, are lacking so far.

OBJECTIVE

To describe esophageal alternation patterns in different parkinsonian syndromes and to look for differences supporting the hypothesis of alpha-synuclein aggregation being linked to gastrointestinal impairment in parkinsonian syndromes.

METHODS

We performed an analysis and comparison of esophageal high-resolution manometry examination parameters in 10 patients with Parkinson's disease, 10 patients with multiple system atrophy (both alpha-synucleinopathies), 10 patients with progressive supranuclear palsy (tauopathy), and 10 age-matched controls. Additionally, pharyngeal dysphagia was evaluated by an endoscopic examination of swallowing in all three patient groups.

RESULTS

Statistically significant lower values for esophageal peristalsis and distal contractile integral were found for both groups of alpha-synucleinopathies (Parkinson's disease and multiple system atrophy) in comparison to the patients with tauopathy (progressive supranuclear palsy group), as well as the age-matched controls, where pathological pharyngeal findings were similar in all patient groups.

CONCLUSIONS

Subtle esophageal motility alterations in parkinsonian syndromes seem to be limited to alpha-synucleinopathies, but are not measurable in tauopathies, indicating a causative connection between pathological alpha-synuclein aggregation in gastrointestinal tissues and esophageal involvement.