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Advanced Neurology Gastrointestinal symptoms in PD

symptoms in patients with PD. BoNT-A and BoNT-B 4.3. Gastroparesis
have an onset time of 1 week and the effects last for about 4.3.1. Evaluation
3–5 months after injection. Ultrasound-guided BoNT
injection may be more effective and safer . Gastric emptying scintigraphy is the gold standard for
[39]
evaluating gastric emptying. Patients ingest a scrambled
Non-pharmaceutical therapies include behavioral
therapy and radiotherapy. Behavioral therapy, such as egg meal labeled with 18.5–37 MBq of technetium-99m
sulfur colloid, and then, continuous imaging is performed
chewing gum and advising patients to swallow at a fixed for 120 min (1 min per frame) to enable the calculation
time, can help patients with PD to alleviate excessive of the half-life of gastric emptying . Gastric emptying is
[54]
salivation . At 1 month after receiving 12 Gy bilateral also evaluated using the C-sodium acetate breath test .
[41]
13
[55]
radiation therapy in the parotid and submandibular
glands, patients with PD show significant improvements Gastroparesis symptoms can be evaluated by daily diary
[56]
in excessive salivation, and this effect lasts for 1 year . questionnaire, which is simple and easy to implement .
[42]
However, radiotherapy can only be used as adjuvant In addition, the three-dimensional transmission system is a
therapy in refractory cases. new approach to calculate the transmission time and motion
mode of the GI region based on the position of an ingested
[57]
4.2. Dysphagia wireless electromagnetic capsule . In contrast to gastric
emptying scintigraphy, the three-dimensional transmission
4.2.1. Evaluation
system method can be carried out in the patient’s residence,
Patients with PD have problems such as transporting and is safe and well tolerated because it is carried out under
food slowly in the oral phase, oral tremoring, and reduced near-normal physiological conditions; it can also evaluate
tongue movement. The swallowing function of patients the function of the small intestine. The reliability of the data
with PD is evaluated using barium swallow radiography , acquired from the three-dimensional transmission system is
[43]
fluoroscopy , and the Munich dysphagia test . In similar to that of gastric emptying scintigraphy.
[45]
[44]
addition, patients with PD have insufficient relaxation of
the upper esophageal sphincter . Patients with severe 4.3.2. Management
[46]
PD show a significant decrease in velopharyngeal and In patients with gastric emptying disorders, the use of
oropharyngeal pressure. Therefore, high-resolution macrolide drugs such as erythromycin or azithromycin
pharyngeal manometry is used to detect subtle shortens the half-life of gastric emptying . Nizatidine,
[54]
abnormalities by quantifying the swallowing pressure of a selective histamine H2 receptor antagonist and a
patients with PD. Evaluating the swallowing pressure is cholinomimetic, improves gastric emptying in patients with
helpful to understand the neuromuscular dysfunction PD . TZP-102 is an effective agonist of oral ghrelin that
[55]
caused by abnormal pressure during swallowing in patients improves the symptoms of type-2A diabetic gastroparesis .
[55]
[47]
with PD . However, there is no persuasive evidence that BoNT injection
4.2.2. Management into the pylorus significantly alleviates the subjective
symptoms and improves the objective measurements of
The treatment of esophageal dysfunction in patients with gastroparesis . Subthalamic deep brain stimulation (STN-
[55]
PD is rare and difficult. At present, there is no effective DBS) may improve the dysfunction of patients with PD by
drug to improve swallowing function. Levodopa is regulating the nervous system that controls GI function .
[58]
thought to improve the swallowing function because Permanent gastric electrical stimulation achieves a good
dopaminergic substitutes improve posture, breathing, and response in 71% of patients with intractable gastroparesis
tongue movement . Non-pharmaceutical techniques, during 2 years of follow-up . In patients with PD, the extract
[48]
[59]
such as chin-down swallowing and the addition of of the dietary herb Rikkunshito shortens gastric emptying
thickening agent , and Lee Silverman speech therapy , assessed by the C-sodium acetate expiration breath test .
[50]
[49]
[55]
13
have also been shown to partially improve the swallowing
function of patients with PD. Impaired cricopharyngeal 4.4. Constipation
relaxation can be improved by surgical cricopharyngeal 4.4.1. Evaluation
myotomy or BoNT injection . However, this operation
[52]
[51]
increases the risk of aspiration in patients with esophageal The Rome III criteria have been widely used in the
dyskinesia or lower esophageal sphincter dysfunction evaluation of functional intestinal diseases since being
with gastroesophageal reflux. Percutaneous endoscopic published in 2006, and Part C3 is used in the evaluation
gastrostomy may be necessary for severe and refractory of functional constipation. The Rome standard is an
dysphagia, but is rarely performed in patients with PD internationally recognized objective definition of
because of the invasiveness of the procedure . constipation that mainly focuses on six symptoms :
[60]
[53]
Volume 1 Issue 1 (2022) 5 https://doi.org/10.36922/an.v1i1.9