Objective: To conduct a comprehensive cross-sectional and longitudinal characterization of gastrointestinal dysfunction (GID) in Parkinson’s disease (PD).

Background: GID is an important feature of PD and may play a role in disease pathogenesis. However, studies examining GID in PD are heterogenous and involve patients at different disease stages. Furthermore, there is very little longitudinal data on GID symptoms in PD.

Method: Participants with REM Sleep Behaviour Disorder (RBD) at high risk of developing PD, participants with PD and controls completed the Gastrointestinal Dysfunction Scale – Parkinson’s Disease (GIDS-PD). Patients were assessed using the MDS-UPDRS and Hoehn and Yahr staging (H&Y). Information on lifestyle variables such as diet, water intake, exercise habits, smoking was collected as well as levodopa-equivalent daily dose, and relevant medication history (opioids, anticholinergics, laxatives). Participants were stratified by H&Y stage and GID was compared across disease stages. A subset of participants completed the GIDS-PD longitudinally after a minimum of 1 year. Data collection is ongoing.

Results: The current sample is composed of 289 participants with PD (H&Y1=51, H&Y2= 189, H&Y3=30, H&Y4=19), 27 participants with RBD and 52 household controls. A subset of 107 participants with PD completed the GIDS-PD longitudinally with an average follow-up of 1.5±0.3 years. Of the 289 PD participants, 48.8% employed extra measures such as a special diet or laxative use to improve bowel function, and 29.8% were constipated according to the validated GIDS-PD cut-off score of 9. Preliminary analysis shows GIDS-PD Constipation scores were higher in RBD and PD groups at H&Y 2-5 (but not H&Y 1) when compared to controls (p<0.0001). There were no significant between-group differences in Bowel Irritability. GIDS-PD Upper GI scores were higher in advanced PD (H&Y4) compared to controls and RBD cases. Paired longitudinal analysis indicate that GIDS-PD scores remain stable over a mean of 1.5 years.

Conclusion: GI symptoms, particularly constipation, occur in a proportion of RBD cases before the onset of PD. GID is relatively stable over time but there was a slow incremental increase in symptom burden across PD stages, and some patients do not experience significant GID even in late stage disease underlining the heterogeneity of gut involvement in the disease.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/characterization-of-gastrointestinal-dysfunction-in-parkinsons-by-disease-stage/