Objective: To assess distal functional gastrointestinal (GI) symptoms and their connection to fecal microbiota (FM) in Parkinson (PD) patients.

Background: The majority of PD patients suffer from GI symptoms of which usually constipation is mentioned as the most prominent. Constipation is one of the strongest risk factors for PD, and recently also irritable bowel syndrome (IBS) was linked to PD. Gut microbiota alterations were recently described in PD. We wanted to assess functional GI symptoms in PD and their possible connection to other non-motor symptoms (NMS) and FM.

Methods: This case-control study compared 74 patients with a diagnosis of PD according to the Queen Square Brain Bank criteria with 75 sex- and age-matched control subjects without any signs of parkinsonism or potential premotor symptoms. The prevalence and overall severity of NMS was assessed using the NMS Questionnaire (NMSQuest). Distal functional GI symptoms were assessed using the Rome III questionnaire. FMs were compared by pyrosequencing of the V1-V3 regions of the bacterial 16S ribosomal RNA gene.

Results: IBS was significantly more prevalent in PD patients than in controls (24.3 % vs. 5.3 %; p=0.001). The most common subtype in PD patients was mixed IBS (IBS-M; 14.9 %). Prevalence of constipation-predominant (IBS-C) and diarrhea-predominant IBS (IBS-D) in PD patients were 6.8 %, and 1.4 %, respectively. In addition, 12.2 % of PD patients and 6.7 % of controls suffered from functional constipation (FC) (p=0.072).

Table 1

	Parkinson (n=74)	Control (n=75)	p-value
IBS	24.3 %	5.3 %	0.001
IBS-C	6.8 %	2.7 %	0.276
IBS-D	1.4 %	0.0 %	0.497
IBS-M	14.9 %	2.7 %	0.009
FC	12.2 %	4.0 %	0.078

The prevalence of irritable bowel syndrome (IBS) and functional constipation (FC) in Parkinson patients and controls. (IBS-C = constipation predominant, IBS-D = diarrhea predominant, IBS-M = mixed, IBS-U = unsubtyped” PD patients had hard or lumpy stools, straining at defecation, abdominal pain or discomfort, and incomplete emptying of bowels more commonly than decreased bowel frequency. PD patients with IBS (IBS+) also had more other NMSs than PD patients without IBS (IBS-), although there was no difference in motor symptoms. The analysis of FM showed a lower abundance of Prevotella bacteria in IBS+ patients compared to IBS-.

Conclusions: The high prevalence of PD patients who fulfill the criteria for IBS, and IBS-M being the most common subtype indicates that, in addition to constipation, patients may suffer from a broader spectrum of distal GI symptoms. A more systematic assessment of functional GI symptoms could add value to assessment of NMS in PD. The lower abundance of Prevotella bacteria in IBS+ may indicate that microbiota play a role in GI symptoms of PD patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/irritable-bowel-syndrome-is-more-prevalent-than-functional-constipation-in-parkinsons-disease-clinical-spectrum-and-changes-in-gut-microbiota/