Quigley E M
Section of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, USA.
Semin Neurol. 1996 Sep;16(3):245-50. doi: 10.1055/s-2008-1040981.
Gastrointestinal dysfunction is common and clinically important in patients with PD. Evidence continues to accumulate to indicate that these symptoms reflect, for the most part, the direct involvement of the gastrointestinal tract by the PD process. Gastrointestinal symptomatology may arise not only as a consequence of the effects of PD on skeletal muscles in the oropharynx, anorectum, and pelvic floor but also through the direct involvement of the autonomic and enteric nervous systems in the PD process. While many aspects of gastrointestinal dysfunction in PD continue to be delineated, therapeutic approaches to gut symptoms in this common disorder remain in their infancy. Gut involvement in PD can be seen to serve as a paradigm for gut-CNS interactions. The recent demonstration of neuropathologic abnormalities in the enteric nervous system analogous to those regarded as pathognomonic of the parkinsonian process in the CNS suggests that the enteric and central nervous systems may demonstrate parallel pathologic changes in a number of disease processes previously regarded as confined to the central and somatic nervous systems. In this way, the enteric nervous system may well serve as a more accessible "window" to a variety of degenerative neurologic disorders. With respect to PD itself, we can begin to relate both the neurologic and gastrointestinal manifestations of this disorder to defects at a number of levels (Table 1).
胃肠道功能障碍在帕金森病（PD）患者中很常见且具有临床重要性。越来越多的证据表明，这些症状在很大程度上反映了PD病变对胃肠道的直接影响。胃肠道症状的出现不仅可能是由于PD对口咽、肛门直肠和盆底骨骼肌的影响，还可能是由于自主神经系统和肠神经系统直接参与了PD病变过程。虽然PD患者胃肠道功能障碍的许多方面仍在进一步明确，但针对这种常见疾病肠道症状的治疗方法仍处于起步阶段。肠道受累在PD中可被视为肠道与中枢神经系统（CNS）相互作用的一个范例。最近在肠神经系统中发现的神经病理异常与那些被认为是中枢神经系统帕金森病病变特征性的异常相似，这表明在一些以前被认为局限于中枢和躯体神经系统的疾病过程中，肠神经系统和中枢神经系统可能会出现平行的病理变化。通过这种方式，肠神经系统很可能成为了解各种退行性神经系统疾病的一个更容易接近的“窗口”。就PD本身而言，我们可以开始将这种疾病的神经学和胃肠道表现与多个层面的缺陷联系起来（表1）。
