Objective: To perform a comprehensive assessment of constipation in Parkinson’s disease (PD) using various complementary diagnostic techniques to elucidate its pathophysiology and improve its symptomatic management

Background: Despite the contribution to the non-motor clinical burden and potential role in PD pathogenesis, the pathophysiological mechanisms of constipation in PD are poorly understood.

Method: Patients with a diagnosis of PD according to the UK Brain Bank criteria and complaints of constipation were recruited from a PD specialist clinic between 2016-2018. Demographic and clinical features of PD and medications were recorded. Participants were evaluated with validated clinical questionnaires to assess constipation severity, colonic transit studies, high-resolution anorectal manometry and MRI defecography.

Results: 42 patients (69% male; age 68 ± 8 years; disease duration 11 ± 6 years) were included. 33 (78.6%) had objective constipation defined by < 3 bowel movements/week or straining. Severity of constipation correlated with severity of disease (HY stage), motor (MDS-UPDRS) and non-motor symptoms (NMSQ) but not with age, disease duration or PD medications. 15 patients underwent assessment of slow transit and anorectal function (high-resolution anorectal manometry and/or MRI defecography). A combination of both delayed colonic transit and anorectal dysfunction was the pattern most commonly found (60%) and overall anorectal dysfunction was more prevalent than isolated slow transit constipation. Abnormal physiological findings were heterogeneous including reduced colonic motility, rectal hyposensitivity and defecatory dyssynergia.

Conclusion: Multiple complex overlapping pathophysiological mechanisms are responsible of constipation in PD. Several complementary investigations are required for a systematic assessment and symptomatic management should be guided by the underlying pathophysiological abnormalities in those with refractory symptoms.

References: Fasano A, Visanji NP, Liu, LW, Lang AE, Pfeiffer RF. Gastrointestinal dysfunction in Parkinson’s disease. Lancet Neurol 2015;14(6):625-639. Knudsen K, Krogh K, Ostergaard K, Borghammer P. Constipation in Parkinson’s disease: Subjective symptoms, objective markers, and new perspectives. Mov Disord 2017;32(1):94-105.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/comprehensive-clinico-pathophysiological-assessment-of-constipation-in-parkinsons-disease/