The pharmacological management of constipation in patients with Parkinson’s disease: a much-needed relief

ABSTRACT

Introduction

Constipation is common in patients with Parkinson’s disease (PD). Due to the considerable negative outcomes of constipation, significant efforts have been made to prevent and manage chronic constipation in these patients.

Areas covered

Herein, the authors review some of the known pathophysiological causes for slow gastrointestinal (GI) transit in PD patients and the different pharmacological options. All relevant clinical and experimental data found through online databases were included. Bulking agents, osmotic and stimulant laxatives, chloride channel activators, ghrelin agonists, 5-HT4 receptor agonists, and probiotics are some of the proposed medicinal agents. of the authors further review the evidence on alpha-synuclein and botulinum neurotoxin in these patients. It should be noted, however, that some of these interventions are required to be further validated.

Expert opinion

Reduction of GI transit and dysfunction of the anorectum is obvious in PD, affecting the incidence of constipation and thus, quality of life (QOL). Furthermore, due to an inadequate and delayed absorption of oral anti PD medications, dose adjustments and changes in the route of administration are recommended.

KEYWORDS:

• Constipation
• dopamine
• gastrointestinal motility
• Parkinson’s disease
• pharmacological therapy
• precision medicine

Article highlights

• Constipation is one of the most prevalent non-motor symptoms in patients with PD. It precedes the occurrence of motor symptoms in some patients and is considered as a disabling factor conversely affecting patient quality of life.

• Mismanagement of constipation in PD leads to intestinal occlusion and impaired efficient therapeutic responses to anti PD medications because of defective absorption.

• The brain-gut-enteric microbiome axis is considered to play a key role in GI motility through interactions between the enteric and central nervous systems.

• The administration of several types of probiotics and prebiotics were more effective in comparison to placebo. Probiotics increased the frequency of bowel movement.

• Some available pharmacological treatments are considered to be efficacious for constipation management in PD patients. Polyethylene glycol, lubiprostone, prucalopride, mosapride, and linaclotide have been verified to exert improvements in bowel movement frequency in PD patients.

• Botulinum neurotoxin is also suggested for the management of PD associated constipation.

This box summarizes key points contained in the article.

Acknowledgments

The authors thank Taraneh Mousavi for her English language editing.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose

Additional information

Funding

This manuscript has not been funded.