Warnecke T, Schäfer K-H, Claus I, Del Tredici K, Jost W H
Department of Neurology with Institute of Translational Neurology, University Hospital of Münster, 48149, Münster, Germany.
Research and Transfer Working Group Enteric Nervous System (AGENS), University of Applied Sciences Kaiserslautern, Campus Zweibrücken, 66482, Zweibrücken, Germany.
NPJ Parkinsons Dis. 2022 Mar 24;8(1):31. doi: 10.1038/s41531-022-00295-x.
Growing evidence suggests an increasing significance for the extent of gastrointestinal tract (GIT) dysfunction in Parkinson's disease (PD). Most patients suffer from GIT symptoms, including dysphagia, sialorrhea, bloating, nausea, vomiting, gastroparesis, and constipation during the disease course. The underlying pathomechanisms of this α-synucleinopathy play an important role in disease development and progression, i.e., early accumulation of Lewy pathology in the enteric and central nervous systems is implicated in pharyngeal discoordination, esophageal and gastric motility/peristalsis impairment, chronic pain, altered intestinal permeability and autonomic dysfunction of the colon, with subsequent constipation. Severe complications, including malnutrition, dehydration, insufficient drug effects, aspiration pneumonia, intestinal obstruction, and megacolon, frequently result in hospitalization. Sophisticated diagnostic tools are now available that permit more detailed examination of specific GIT impairment patterns. Furthermore, novel treatment approaches have been evaluated, although high-level evidence trials are often missing. Finally, the burgeoning literature devoted to the GIT microbiome reveals its importance for neurologists. We review current knowledge about GIT pathoanatomy, pathophysiology, diagnosis, and treatment in PD and provide recommendations for management in daily practice.
越来越多的证据表明，胃肠道（GIT）功能障碍在帕金森病（PD）中的程度日益重要。大多数患者在病程中会出现胃肠道症状，包括吞咽困难、流涎、腹胀、恶心、呕吐、胃轻瘫和便秘。这种α-突触核蛋白病的潜在病理机制在疾病的发生和发展中起着重要作用，即路易体病理在肠道和中枢神经系统的早期积累与咽部协调障碍、食管和胃动力/蠕动受损、慢性疼痛、肠道通透性改变以及结肠自主神经功能障碍有关，随后导致便秘。严重并发症，包括营养不良、脱水、药物疗效不佳、吸入性肺炎、肠梗阻和巨结肠，经常导致住院。现在有了精密的诊断工具，可以对特定的胃肠道损伤模式进行更详细的检查。此外，尽管往往缺乏高水平证据的试验，但已经对新的治疗方法进行了评估。最后，关于胃肠道微生物群的新兴文献揭示了其对神经科医生的重要性。我们回顾了目前关于帕金森病中胃肠道病理解剖、病理生理、诊断和治疗的知识，并为日常实践中的管理提供建议。
