Utility of the wireless motility capsule and lactulose breath testing in the evaluation of patients with Parkinson's disease who present with functional gastrointestinal symptoms

Abstract

BackgroundThe aetiology and origin of gastrointestinal symptoms in Parkinson's disease (PD) remains poorly understood. Gastroparesis, small bowel transit delay and bacterial overgrowth may, individually or collectively, play a role.AimsIn patients with PD and functional gastrointestinal symptoms, we aimed to determine the utility of the wireless motility capsule and lactulose breath tests in further defining their symptoms' aetiology.MethodsIn this retrospective cohort study, consecutive patients with PD and functional gastrointestinal symptoms underwent clinical assessment, as well as wireless motility capsule and lactulose breath testing using standard protocols.ResultsWe studied 65 patients with PD and various gastrointestinal symptoms. 35% exhibited gastroparesis by the wireless motility capsule study, 20% small bowel transit delay, while 8% had combined transit abnormalities, suggestive of overlapping gastric and small bowel dysmotility. Small bowel bacterial overgrowth was seen in 34% of cases. Symptoms of abdominal pain, regurgitation, bloating, nausea, vomiting, belching and weight loss could not distinguish between patients with or without gastroparesis, although bloating was significantly more prominent (p<0.001) overall and specifically more so in patients with slow small bowel transit (p<0.01). There was no relationship between delayed small bowel transit time and bacterial overgrowth (p=0.5); PD scores and duration were not correlated with either the transit findings or small bowel bacterial overgrowth.ConclusionsFunctional gastrointestinal symptoms in patients with PD may reflect gastroparesis, small bowel transit delay or both, suggesting motor and/or autonomic dysfunction, and may be associated with small bowel bacterial overgrowth. The wireless motility capsule and lactulose breath testing are non-invasive and useful in the assessment of these patients.

Gastrointestinal Dysfunction in Parkinson’s Disease

“…Small intestinal transit has been investigated using different ambulatory systems comprised of an ingestible capsule and a wireless data receiver [ 102 , 103 , 104 ]. These studies reported a delay in small intestinal transit time in PD compared to matched controls, although the magnitude of delayed transit was less marked than that seen in the colon.…”

Association of small intestinal bacterial overgrowth with Parkinson’s disease: a systematic review and meta-analysis

“…Of all the extracted articles, 245 articles were excluded because they were duplicates, reviews, or irrelevant studies. Finally, 11 studies [ 7 , 10 – 19 ] (7 cross-sectional studies and 4 cohort studies) with 973 participants (692 PD patients and 281 controls) met the inclusion criteria (Fig. 1 ).…”

“…New work suggests a strong association between PD and SIBO. The prevalence of SIBO in PD reported in recent research was 34% [ 7 ]. However, current studies do not provide explicit evidence to confirm the correlation at home and abroad.…”

Clinical implications of gastric complications on levodopa treatment in Parkinson's disease

“…However, in people with types 1 and 2 diabetes, rates of gastroparesis overall are estimated to be approximately 5% and 1%, respectively, and are reported to be 40% and 10-20%, respectively, at tertiary care medical centers, where reported rates are likely to be elevated [33,48]. Formal prevalence studies of gastroparesis have not been performed in patients with PD, but reports involving small patient samples have provided frequency estimates from 35 to 100% [25,49,50]. Prevalence estimates have varied according to the criteria used in studies, because not all patients with DGE experience GI symptoms [25].…”