Edwards L L, Quigley E M, Harned R K, Hofman R, Pfeiffer R F
Department of Internal Medicine, University of Nebraska Medical Center, Omaha.
Am J Gastroenterol. 1994 Jan;89(1):15-25.
Despite the high prevalence of Parkinson's disease, the pathophysiology of its gastrointestinal symptoms remains poorly understood.
to evaluate swallowing and defecatory function in patients with Parkinson's disease and age- and sex-matched controls and to correlate objective findings with subjective symptoms.
The following studies were performed on 13 patients with Parkinson's disease and seven controls: extrapyramidal function assessment, gastrointestinal symptom survey, videoesophagram, colon transit study, defecography, and anorectal manometry.
Abnormal salivation (frequency, %, control vs. Parkinson's disease: 14 vs. 77, p < 0.05), dysphagia (14 vs. 77, p < 0.05), constipation (14 vs. 31, p < 0.05), and defecatory dysfunction (29 vs. 77, p < 0.05) were more common among Parkinsonian patients. However, videoesophagographic abnormalities were equally common in both groups. Colon transit time was significantly prolonged in the Parkinson's disease group. Altered puborectalis function was noted on defecography in 31% of Parkinson's disease subjects, but in none of the controls (p < 0.05). Anorectal manometry identified several abnormalities in the Parkinson's disease group, which included decreased basal anal sphincter pressures, prominent phasic fluctuations on squeeze, and a hyper-contractile external sphincter response to the rectosphincteric reflex. Many patients exhibited both slow transit and manometric abnormalities, and symptoms were poor predictors of test results.
In this group of patients with mild to moderate Parkinson's disease, videoesophagographic abnormalities were not confined to the patients with Parkinson's disease. Studies of colonic and anorectal function, in contrast, identified a number of abnormalities. Therefore, colonic and anorectal dysfunction appears to be an early gastrointestinal manifestation of Parkinson's disease, and may represent the direct involvement of the gut by this disease process.
尽管帕金森病的患病率很高，但其胃肠道症状的病理生理学仍知之甚少。
评估帕金森病患者以及年龄和性别匹配的对照组的吞咽和排便功能，并将客观发现与主观症状相关联。
对13例帕金森病患者和7例对照组进行了以下研究：锥体外系功能评估、胃肠道症状调查、视频食管造影、结肠运输研究、排粪造影和肛肠测压。
帕金森病患者流涎异常（频率，%，对照组与帕金森病组：14 vs. 77，p < 0.05）、吞咽困难（14 vs. 77，p < 0.05）、便秘（14 vs. 31，p < 0.05）和排便功能障碍（29 vs. 77，p < 0.05）更为常见。然而，视频食管造影异常在两组中同样常见。帕金森病组的结肠运输时间显著延长。31%的帕金森病患者在排粪造影中发现耻骨直肠肌功能改变，而对照组均未发现（p < 0.05）。肛肠测压发现帕金森病组有几种异常，包括基础肛门括约肌压力降低、挤压时明显的相位波动以及外括约肌对直肠括约肌反射的过度收缩反应。许多患者同时存在运输缓慢和测压异常，症状对检查结果的预测性较差。
在这组轻度至中度帕金森病患者中，视频食管造影异常并不局限于帕金森病患者。相比之下，结肠和肛肠功能研究发现了一些异常。因此，结肠和肛肠功能障碍似乎是帕金森病早期的胃肠道表现，可能代表了该疾病过程对肠道的直接影响。
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