The treatment of gastroparesis, constipation and small intestinal bacterial overgrowth syndrome in patients with Parkinson’s disease

Abstract

Introduction: Parkinson’s disease (PD) affects the nerves of the entire gastrointestinal (GI) tract and may result in profound gastrointestinal (GI) dysfunction leading to poor patient outcomes. Common GI disturbances in patients with PD include gastroparesis (GP), constipation and small intestinal bacterial overgrowth syndrome (SIBO). In particular, GP is difficult to treat due to the limited options available and precautions, contraindications and adverse effects associated with the approved treatments. Moreover, some commonly used medications can worsen pre-existing PD.

Areas covered: Our review will focus on treatment options for GP and SIBO with motilin agonists, dopamine receptor antagonists, Ghrelin agonists muscarinic agonists, 5-HT₄ receptor agonists, antibiotics, probiotics and herbal formulation such as iberogast. Constipation occurs in the majority of patients with PD and fortunately many treatments are now available. Our review is based on original papers or reviews selected from PUBMED search and Cochrane reviews.

Expert opinion: Motility disorders of the GI tract are found frequently in patients with PD and treating the underlying GI disorders caused by PD with various prokinetics and laxatives is paramount in achieving improvements in patient’s motor function. Various prokinetics and laxatives are now available to provide some relief of the GI morbidity caused by PD leading even to better absorption of even the PD treatments.

Keywords:

• 5-HT₄ receptor agonists
• probiotics
• autonomic nervous system dysfunction
• azithromycin
• constipation
• domperidone
• dysmotility
• erythromycin
• gastrointestinal
• gastroparesis
• iberogast
• PEG
• linaclotide
• lubiprostone
• mosapride
• nizatidine
• non-motor symptoms
• Parkinson’s disease
• prucalopride
• rifaximin
• RM-131
• small intestinal bacterial overgrowth syndrome
• STW5
• TZP-101
• TZP-102
• ulimorelin

Declaration of interest

MS Okun serves as a consultant for the National Parkinson foundation and has received grants from NIH, National Parkinson Foundation, the Michael J Fox Foundation, the Parkinson Alliance, Smallwood Foundation, the Bachmann-Strauss Foundation, the Tourette Syndrome Association and the University of Florida Foundation. MS Okun has previously received honoraria, but in the past > 60 months has received no support from industry. MS Okun has received royalties for publications with Demos, Manson, Amazon, Smashwords, Books4Patients and Cambridge (movement disorder books). He is an associate Editor for the New England Journal of Medicine Journal Watch Neurology. He has participated in continuing medical education and educational activites on movement disorders (in the last 36 months) sponsored by PeerView, Prime, Quantia, Henry Stewart and by Vanderbilt University. MS Okun’s institution has received grants from Medtronic, Abbvie, and St. Jude Medical, and the principle investigator has no financial interest in these grants. MS okun has participated as a site principal investigator and/or co-investigator for several NIH, foundation and industry trials over the years but has not received honoraria. B Moshiree has received grants from and is both a consultant and speaker for Green Imaging. He has received grants from and is on the advisory board of Promethius Laboratories. The authors have no other 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 apart from those disclosed.

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