Department of Neurology, Clinical Admin 3E, Level 3, ASB, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW, 2065, Australia.
Department of Neurogenetics, Kolling Institute, Faculty of Medicine and Health, University of Sydney and Northern Sydney Local Health District, St Leonards, NSW, Australia.
J Neurol. 2020 May;267(5):1377-1388. doi: 10.1007/s00415-020-09723-5. Epub 2020 Jan 27.
Gastrointestinal (GI) dysfunction is prevalent in Parkinson's disease (PD). Symptoms are evident throughout the disease course, affect the length of the GI tract and impact on patient quality of life and management. We clarify real-life differences in the frequency and severity of GI symptoms in a cohort of PD and healthy control (HC) subjects.
103 PD patients were compared to 81 HC subjects. Outcome measures collected from validated questionnaires included constipation severity, upper and lower GI symptoms and physical activity.
PD patients were three-times more likely to experience constipation than HC subjects, (78.6% vs 28.4%), exhibited a fourfold increase in constipation severity and formed harder stools. PD patients also reported increased symptoms of indigestion, nausea, excessive fullness and bloating, compared to the HCs. A higher mean Leeds Dyspepsia Questionnaire score for PD patients (8.3 (standard deviation (SD) 7.7) vs 4.6 (SD 6.1), p = 0.001)) indicated increased symptom severity. Chronic pain was more frequently reported and correlated with constipation and upper GI dysfunction, being more prevalent and severe in women. Physical activity was notably decreased in the PD cohort (1823.6 (± 1693.6) vs 2942.4 (± 2620.9) metabolic equivalent-minutes/week, p = 0.001) and correlated with constipation severity. PD therapies were associated with increased fullness and bloating and harder stools.
PD patients report more prevalent and severe GI dysfunction, although our cohort comprised of many later-stage participants. Earlier recognition of GI dysfunction in PD provides the opportunity to direct treatment for chronic pain and constipation, promote physical activity and rationalise PD therapies for optimal patient care.
胃肠道（GI）功能障碍在帕金森病（PD）中很常见。症状在整个疾病过程中都很明显，影响胃肠道的长度，并影响患者的生活质量和治疗。我们澄清了 PD 患者和健康对照组（HC）受试者在 GI 症状的频率和严重程度方面的真实差异。
将 103 名 PD 患者与 81 名 HC 受试者进行比较。从经过验证的问卷中收集的结果测量包括便秘严重程度、上消化道和下消化道症状以及体力活动。
PD 患者比 HC 受试者更容易出现便秘，（78.6%比 28.4%），便秘严重程度增加了四倍，粪便更硬。与 HC 相比，PD 患者还报告了更多的消化不良、恶心、过度饱胀和腹胀症状。PD 患者的 Leeds 消化不良问卷评分平均值更高（8.3（标准差（SD）7.7）比 4.6（SD 6.1），p=0.001），表明症状更严重。慢性疼痛更频繁地报告，并与便秘和上消化道功能障碍相关，在女性中更为普遍和严重。PD 队列中的体力活动明显减少（1823.6（±1693.6）比 2942.4（±2620.9）代谢当量分钟/周，p=0.001），并与便秘严重程度相关。PD 治疗与饱腹感增加、腹胀和粪便变硬有关。
PD 患者报告的胃肠道功能障碍更为普遍和严重，尽管我们的队列包含许多晚期患者。在 PD 中更早地识别胃肠道功能障碍为治疗慢性疼痛和便秘、促进体力活动和合理使用 PD 治疗提供了机会，以实现患者护理的最佳效果。
