Session Information
Date: Tuesday, September 24, 2019
Session Title: Parkinsonisms and Parkinson-Plus
Session Time: 1:45pm-3:15pm
Location: Agora 3 West, Level 3
Objective: To perform a comprehensive assessment of constipation in Parkinson’s disease (PD) using various complementary diagnostic techniques to elucidate its pathophysiology and improve its symptomatic management
Background: Despite the contribution to the non-motor clinical burden and potential role in PD pathogenesis, the pathophysiological mechanisms of constipation in PD are poorly understood.
Method: Patients with a diagnosis of PD according to the UK Brain Bank criteria and complaints of constipation were recruited from a PD specialist clinic between 2016-2018. Demographic and clinical features of PD and medications were recorded. Participants were evaluated with validated clinical questionnaires to assess constipation severity, colonic transit studies, high-resolution anorectal manometry and MRI defecography.
Results: 42 patients (69% male; age 68 ± 8 years; disease duration 11 ± 6 years) were included. 33 (78.6%) had objective constipation defined by < 3 bowel movements/week or straining. Severity of constipation correlated with severity of disease (HY stage), motor (MDS-UPDRS) and non-motor symptoms (NMSQ) but not with age, disease duration or PD medications. 15 patients underwent assessment of slow transit and anorectal function (high-resolution anorectal manometry and/or MRI defecography). A combination of both delayed colonic transit and anorectal dysfunction was the pattern most commonly found (60%) and overall anorectal dysfunction was more prevalent than isolated slow transit constipation. Abnormal physiological findings were heterogeneous including reduced colonic motility, rectal hyposensitivity and defecatory dyssynergia.
Conclusion: Multiple complex overlapping pathophysiological mechanisms are responsible of constipation in PD. Several complementary investigations are required for a systematic assessment and symptomatic management should be guided by the underlying pathophysiological abnormalities in those with refractory symptoms.
References: Fasano A, Visanji NP, Liu, LW, Lang AE, Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2015;14(6):625-639. Knudsen K, Krogh K, Ostergaard K, Borghammer P. Constipation in Parkinson’s disease: Subjective symptoms, objective markers, and new perspectives. Mov Disord 2017;32(1):94-105.
To cite this abstract in AMA style:
E. de Pablo-Fernandez, V. Passananti, N. Zárate-López, A. Emmanuel, T. Warner. Comprehensive clinico-pathophysiological assessment of constipation in Parkinson’s disease [abstract]. Mov Disord. 2019; 34 (suppl 2). https://www.mdsabstracts.org/abstract/comprehensive-clinico-pathophysiological-assessment-of-constipation-in-parkinsons-disease/. Accessed December 11, 2024.« Back to 2019 International Congress
MDS Abstracts - https://www.mdsabstracts.org/abstract/comprehensive-clinico-pathophysiological-assessment-of-constipation-in-parkinsons-disease/