Is there a difference in gastric emptying between Parkinson’s disease patients under long-term l-dopa therapy with and without motor fluctuations? An analysis using the 13C-acetate breath test

Abstract

The mechanism underlying the motor fluctuations that develop after long-term L-dopa therapy is not fully known. It has been speculated that malabsorption of L-dopa from the small intestine occurs. It was reported that gastric retention in Parkinson's disease (PD) patients with motor fluctuations is increased as compared with that in PD without fluctuations. Because L-dopa therapy may worsen the symptoms of delayed gastric emptying (GE), it was not clear whether the delayed GE of PD patients with motor fluctuation was affected by L-dopa therapy. We assessed GE in PD patients with and without motor fluctuations. We investigated GE in 40 patients with PD under long-term L-dopa therapy, 20 fluctuators with "delayed-on" and "noon" phenomena, 20 nonfluctuators, and 20 healthy volunteers. GE was examined by the 13C-acetate breath test ((13)CABT) [the half emptying time (HET), the peak time of the (13)C-%-dose-excess curve (T(max))], with expirations collected for 4 h after a test meal and analyzed for (13)CO(2) using an infrared (IR) spectrophotometer. The T(max) of GE as assessed using the (13)C-ABT was significantly delayed in all PD patients as compared with controls (P = 0.002). The HET was significantly delayed in all PD patients as compared with controls (P < 0.001). The T(max) and HET were not significantly delayed in PD patients with motor fluctuations as compared with PD patients without motor fluctuations. These results demonstrated that GE is commonly delayed in PD patients with long-term L-dopa therapy. Delayed GE does not differ between PD patients with and without motor fluctuations. This finding demonstrated that the motor fluctuation in PD may not be influenced by GE.

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“…Tanaka and colleagues used the 13 C-acetate breath test (a non-invasive tool for analysing gastric emptying without radiation exposure) to demonstrate that gastric emptying was delayed in all PD patients, with or without motor fluctuation, compared to healthy volunteers [19]. Delayed gastric emptying was not associated with raised blood concentration of levodopa.…”

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“…The principle of the 13 C-ABT is ingestion of a liquid test meal containing 13 C-acetate, GE, absorption from the digestive tract, metabolism in the liver (production of 13 CO 2 ), and expiration from the lung, which results in an increase in 13 CO 2 in the expired breath [8,9]. Mathematical analysis…”

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“…In normal subjects without any disease of the lung, liver, or small intestine, the peak time of the 13 C-dose-excess curve [T max ( 13 C)] reportedly correlates with gastric emptying function [4,5]. We then obtained the T max ( 13 C) based on the measured change in the ratio of 13 CO 2 to 12 CO 2 [Δ 13 CO 2 (‰)] [4,5]. Statistical analysis was performed using Student's t test.…”

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“…The principle of the breath test is that ingestion of a liquid test meal containing 13 C-acetate results in slower or faster gastric emptying, absorption from the digestive tract, metabolism in the liver (production of 13 CO 2 ), expiration from the lung, and an increase in 13 CO 2 in the expired breath [4,5]. In normal subjects without any disease of the lung, liver, or small intestine, the peak time of the 13 C-dose-excess curve [T max ( 13 C)] reportedly correlates with gastric emptying function [4,5]. We then obtained the T max ( 13 C) based on the measured change in the ratio of 13 CO 2 to 12 CO 2 [Δ 13 CO 2 (‰)] [4,5].…”