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Advanced Neurology Gastrointestinal symptoms in PD

Table 1. (Continued)
Treatment Study design Evaluation method Results Adverse event
Jiawei-Liujunzi Tang [90] Double-blind, randomized, UPDRS questionnaires Effective Dyspepsia (8.9%)
placebo-controlled (n=59 vs. 57)
Abdominal massage [76,79] Qualitative study (n=7 vs. 7) Interview Effective (4/7) No
Isosmotic macrogol solution [76] Double-blind, placebo- Stool frequency, straining, stool Effective Nausea (1/29) and
controlled study (n=29 vs. 28) consistency, use of rectal laxatives diarrhea (1/29)
as a rescue therapy
Psyllium [91] Randomized controlled pilot Stool diary, stool weight, colon Effective No
study (n=4 vs. 3) transit time, and anorectal
manometry

benefits for PD with GI diseases . Another 5-HT4 4.4.2.3. Microbial flora adjustment
[85]
receptor agonist, tegaserod, is approved for the treatment A randomized, double-blind, placebo-controlled trial
of chronic idiopathic constipation. A study of five patients confirmed that the consumption of fermented milk
with PD-related constipation suggested that tegaserod is containing a variety of probiotic strains and prebiotic
well tolerated and improves the defecation frequency and fibers is better than placebo in improving constipation
fecal consistency of most patients . However, another in patients with PD . Probiotics increase the number
[75]
[67]
randomized controlled trial with a small sample size found of spontaneous bowel movements, which improves the
that tegaserod had no significant effect on constipation in constipation severity score , and only cause mild adverse
[68]
patients with PD . reactions such as abdominal discomfort in less than 5%
[77]
One study that treated 18 patients with PD with of patients. A before-after trial also found that probiotics
[69]
outlet constipation with ultrasound-guided injections of improve constipation . However, the long-term effect of
BoNT-A on both sides of the puborectal muscle found a probiotics needs further investigation.
lower pressure during training and an improved anorectal One case report showed that fecal microbiota
angle on defecography after treatment. This suggests transplantation (FMT) temporarily improves PD
that such BoNT-A injections are effective for obstructive symptoms, such as tremoring, and continuously improves
constipation in patients with PD . However, the effect constipation . Another study showed that FMT tends to
[74]
[61]
only lasts for 3 months, so repeated injections may be improve the Wexner constipation score in patients with
required to maintain clinical improvement. Another study PD, but the effect did not reach statistical significance
also reported that BoNT is effective and safe for outlet compared with the control group . FMT is relatively
[73]
obstruction in PD . complex and immature, and there is no fixed standard
[82]
regarding the source of strains. Furthermore, FMT can
4.4.2.2. Physical therapy
only improve the microorganisms in the lumen rather
Functional magnetic stimulation for 3 weeks significantly than the mucosal microbiome , and its improvement of
[94]
reduces the colonic transit time and the Knowles-Eccersley- motor symptoms only lasts for several days. Therefore, the
Scott symptom questionnaire scores by helping to straighten application of FMT in PD needs to be treated with caution.
the anorectal angle, making the rectal contents enter
the anal canal smoothly and improving constipation . 4.4.2.4. Others
[78]
Colonic electrical stimulation also alleviates colonic A healthy diet, such as the Mediterranean diet, can reduce
transmission delay in a rotenone-induced PD model . the occurrence of prodromal symptoms of PD, including
[70]
Abdominal massage, as an adjunct to the management of constipation . However, a study currently investigating
[95]
constipation, offers an acceptable and potentially beneficial whether the Mediterranean diet improves constipation
intervention for patients with PD . STN-DBS increases and other symptoms of PD have not yet been published .
[96]
[70]
anal compression pressure in patients with PD, but does Acupuncture and traditional Chinese medicine may also
not improve anorectal dyssynergia, suggesting that the play a role in the treatment of PD [97,98] . In sitting position,
subthalamic nucleus is involved in the voluntary control it is more difficult to defecate due to the contraction of the
of anorectal movement in patients with PD . A study of puborectal muscles. Therefore, the “squatting position” is
[86]
10 patients showed that STN-DBS improves constipation recommended to relax the puborectal muscles to enable
as assessed by a subjective questionnaire . the elimination of feces more easily and completely .
[88]
[99]
Volume 1 Issue 1 (2022) 8 https://doi.org/10.36922/an.v1i1.9