Esophageal Manometric Abnormalities in Parkinson's Disease

Abstract

The gastrointestinal tract, and especially the esophagus, is frequently involved in neurological diseases; however, objective studies of gut motor function are few. We carried out an esophageal manometric study in 18 patients with various stages of Parkinson's disease (4 stage I, 4 stage II, 7 stage III, and 3 stage IV) to evaluate the function of the viscus in this disease. Clinical assessment showed that 61% complained of esophageal symptoms such as dysphagia, acid regurgitation, pyrosis, and noncardiac chest pain. Manometric abnormalities were documented also in 61% patients, and were represented by repetitive contractions, simultaneous contractions, reduced LES pressure, and high-amplitude contractions. However, only 33.3% of patients had both symptoms and manometric abnormalities. We conclude that esophageal motor abnormalities are frequent in Parkinson's disease, and may appear at an early stage of the disease.

Repetitive Proximal Esophageal Contractions: A New Manometric Finding and a Possible Further Link Between Parkinson's Disease and Achalasia

“…Bramble et al [6] reported their manometric ®ndings in 20 patients, noting normal baseline motility but a signi®cant increase in nonperistaltic activity after the administration of atropine. More recently, repetitive contractions of the esophageal body were noted in 4 of 18 PD patients [7]. No study has described repetitive, spontaneous activity con®ned to the proximal esophagus.…”

Gastrointestinal Features of Parkinson’s Disease

“…The aforementioned abnormalities culminate in increased risk of aspiration, which may occur asymptomatically in as many as 15% to 33% of PD patients, and can lead to pneumonia [11,38,40]. Using videoradiography and esophageal manometry, multiple abnormalities in the esophageal phase have been identified, including incomplete upper esophageal sphincter relaxation and reduced opening, high intrabolus pressure, complete aperistalsis, multiple simultaneous contractions (diffuse esophageal spasms), high-amplitude contractions, prolonged esophageal phase, and reduced lower esophageal sphincter pressure [35,36,41]. These esophageal abnormalities can result in both dysphagia and gastroesophageal reflux.…”

Dysphagia in Aging

“…Esophageal abnormalities included delayed transport, stasis, bolus redirection, and tertiary contractions. 65 Bassotti et al 66 reported esophageal manometric abnormalities in 61% (n = 18) patients with Parkinson's, including repetitive contractions, simultaneous contractions, reduced LES pressure, and high amplitude contractions. However, only 33% of patients had both symptoms and manometric abnormalities.…”