Page 30 - AN-1-1

Advanced Neurology Gastrointestinal symptoms in PD

tense defecation, massive or hard defecation, incomplete with PD. A double-blind controlled trial showed that
defecation, anorectal obstruction or blockage, manual isotonic polyethylene glycol electrolyte solution improves
defecation, and defecation twice or less per week. The constipation in patients with PD . The solution is
[76]
diagnosis of constipation is based on the presence of well tolerated and only causes diarrhea and nausea in a
two or more of these symptoms for more than 3 months. small number of patients. The UPDRS score confirmed
The application of the Rome IV criteria in the evaluation that the treatment does not affect PD motor symptoms.
of PD is currently under discussion. In addition, other However, while taking osmotic laxatives, the patient’s
questionnaires such as the Wexner comparison score cardiac and renal function should be monitored. Based
have been used in some studies . The abovementioned on clinical experience, irritant laxatives (such as senna
[61]
scales are universal in GI evaluation. For PD, the scales and bisacodyl) also play a certain role in constipation
developed to evaluate constipation include the Parkinson’s in patients with PD, but are generally recommended for
autonomic nerve disease prognosis scale and the non- occupational use as a rescue therapy .
[92]
motor symptoms scale. These scales assess the frequency Lubiprostone plays a role locally in the small intestine
of defecation, stress, and fecal incontinence [62,63] , and the by activating the type 2 chloride channel in the intestinal
frequency and severity of the symptoms . apical cell membrane and inducing the secretion of liquid
[64]
In PD, constipation occurs due to slow colonic and electrolytes to speed up the transport time of the small
transmission and/or outlet obstruction. Therefore, intestine and colon. Compared with placebo, lubiprostone
constipation in patients with PD is often assessed using improves the constipation scale, visual analysis scale scores,
physiological evaluation methods, such as the evaluation and daily defecation volume. Furthermore, lubiprostone
of the colonic transit time, high-resolution anorectal only causes mild adverse reactions, most frequently
manometry, and MRI defecography . Patients with PD comprising loose stools in 48% of patients. However, the
[65]
have a significantly prolonged colonic transit time , severity of these symptoms is mild and will not lead to
[66]
while anorectal manometry shows reduced basic anal treatment interruption .
[72]
sphincter pressures, prospective phase adjustments Squalamine rapidly restores the intrinsic primary
on squeeze, and a hypercontractual external sphincter afferent neuron excitability of the ENS to promote
response to the rectosphincteric reflex . However, intestinal propulsion, which may be effective in the
[66]
subjective constipation in PD is poorly correlated with treatment of constipation in patients with PD . Ent-
[81]
[65]
physiological results . Especially for patients with 01 oral tablet (a synthetic squalamine salt) may increase
refractory symptoms, physiological examinations should the number of spontaneous defecations per week in 80%
be combined to evaluate both the colonic transport and of patients through local stimulation of the ENS. An
the anorectal function for systematic evaluation and ongoing double-blind, placebo-controlled study reported
appropriate symptom management. that the common adverse events of Ent-01 include nausea
4.4.2. Management in 21/44 patients (47%) and diarrhea in 18/44 patients
[93]
(40%) .
The treatment of constipation in PD should be
comprehensive. On top of a healthy diet, it is supplemented Cisapride increases the release of acetylcholine from the
with drug therapy, physical therapy, microbial flora myenteric plexus. A preliminary study of 20 patients with
adjustment and so on. After treatment, the symptoms of PD found that cisapride accelerates colonic transmission
constipation could be improved in some PD patients. The and improves constipation, with no “excessive effects” such
[83]
relevant key literature is summarized in Table 1. as adverse reactions and diarrhea .
Mosapride is a selective 5-HT4 receptor agonist that
4.4.2.1. Medication promotes the release of acetylcholine from intestinal
Effective treatments for constipation in patients without cholinergic neurons . In contrast to cisapride, mosapride
[87]
PD are also generally effective in patients with PD, such does not block K channels or D2 dopaminergic receptors.
+
as increasing the fiber intake and taking permeable Evaluation of the colonic transit time before and after
or irritant laxatives. In patients with PD, 4 weeks of treatment in 14 patients with PD with constipation
psyllium administration increase the fecal frequency showed that mosapride citrate enhances the movement of
without changing the colonic transport or anorectal the lower GI tract, thus improving constipation without
[91]
function . However, fiber should be avoided in causing serious adverse reactions. In a 6-OHDA rat
patients with gastroparesis because fiber could delay model, the novel oral active growth hormone-releasing
gastric emptying. Osmotic laxatives are widely used in peptide agonist HM01 crosses the blood–brain barrier and
the general population and are also useful for patients alleviates PD-related constipation, suggesting potential

Volume 1 Issue 1 (2022) 6 https://doi.org/10.36922/an.v1i1.9