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Advanced Neurology

REVIEW ARTICLE
Gastrointestinal symptoms of Parkinson’s

disease: A systematic review from pathogenesis
to management

1
1
2
Xiao-Yu Cheng , Cheng-Jie Mao , Ya-Li Wang *, and Chun-Feng Liu *
1
1 Department of Neurology and Clinical Research Center of Neurological Disease, The Second
Affiliated Hospital of Soochow University, Suzhou, China
2 Department of Neurology, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China

Abstract

The identification of Parkinson’s disease (PD) is mainly dependent on motor
symptoms, while the non-motor symptoms exist even decades ahead of the PD
diagnosis. According to Braak’s hypothesis, the enteric plexus is the first affected
site during the pathological development of PD, and gastrointestinal (GI) symptoms
appear during the onset of the disease. Although GI symptoms decrease the life
quality of patients with PD, there is often less focus on GI symptoms compared with
motor symptoms. In this review, we summarize the pathophysiological basis, clinical
manifestation, diagnosis, and treatment of GI symptoms in patients with PD. We also
discuss the treatment and research dilemmas, as well as the research direction in the
near future.

*Corresponding authors: Keywords: Parkinson’s disease; Non-motor symptoms; Gastrointestinal symptoms; Brain-
Chun-Feng Liu (liuchunfeng@suda. gut axis; Management
edu.cn)
Ya-Li Wang (yjyali@sina.com)
Citation: Cheng X-Y, Mao C-J, Wang
Y-L, et al., 2022, Gastrointestinal
symptoms of Parkinson’s disease: A 1. Introduction
systematic review from pathogenesis
to management. Adv Neuro, 1(1): 9. Parkinson’s disease (PD) is the second most common neurodegenerative disease, and its
https://doi.org/10.36922/an.v1i1.9 incidence is increasing annually. It is estimated that the number of patients with PD in
Received: December 13, 2021 China will rise to about 5 million in 2030, accounting for almost half of the number of
patients with PD worldwide. In addition to the motor symptoms, non-motor symptoms
Accepted: February 23, 2022
contribute to the impaired quality of life, severe disability, and shortened life span
Published Online: March 18, 2022 in advanced PD. The common non-motor symptoms of PD are gastrointestinal (GI)
Copyright: © 2022 Author(s). symptoms, REM sleep behavior disorder, and anosmia. Epidemiological research suggests
This is an Open-Access article that GI symptoms affect more than 80% of patients with PD, which is far greater than
distributed under the terms of the
Creative Commons Attribution the incidence among the healthy population [1-4] . In addition, GI symptoms, including
License, permitting distribution, drooling, dysphagia, gastroparesis, constipation, fecal impaction, and intestinal pseudo-
and reproduction in any medium,
provided the original work is obstruction, often occur for years or even decades before the diagnosis of PD, indicating
properly cited. a close association with PD . However, the recognition and treatment of GI symptoms in
[5]
Publisher’s Note: AccScience patients with PD have not been systematically summarized, and a standardized consensus
Publishing remains neutral with has not been reached. Autopsy reports show that the intestine is the first and typical site
regard to jurisdictional claims in
published maps and institutional to be pathologically affected, suggesting that PD may arise from the intestine. Clinical
affiliations. and in vivo studies have confirmed that intestinal α-synuclein aggregation may spread to

Volume 1 Issue 1 (2022) 1 https://doi.org/10.36922/an.v1i1.9