Objective: To study objectively measured intestinal function, defined by intestinal volume, transit times, and colonic motility patterns in patients with idiopathic REM sleep behaviour disorder (iRBD).

Background: The majority of patients with Parkinson’s disease (PD) report constipation and other gastrointestinal (GI) symptoms. The symptoms often appear years prior to diagnosis and, therefore, support the hypothesis that PD may in some cases start in the gut. Despite constipation being an important and highly prevalent pre-motor symptom, objective testing of intestinal functions has received little attention. The parasomnia iRBD is recognized as an early prodromal feature of PD and dementia with Lewy bodies (DLB), thus representing an opportunity to investigate intestinal dysfunction at the earliest disease phase.

Methods: Twenty-two iRBD patients were included. Total gastrointestinal transit time (GITT) was examined using radio opaque markers; colonic volume was defined on abdominal CT scans, and regional gastric transit time (GTT), small intestinal transit time (SITT), and colonic transit time (CTT) were estimated using the 3D-Transit endo-capsule system. For each examination, data were compared to reference groups of healthy controls (HC) and PD patients.

Results: The iRBD group displayed significantly increased total GITT, colonic volume, and CTT compared to (HC) (p<0.05). Total GITT was delayed in 33% and colonic volume increased in 48% of iRBD patients defined by a ROC analysis. No difference was seen in GTT and SITT between iRBD and HC groups. The objectively measured dysfunction in the iRBD group followed a similar pattern as seen in diagnosed PD patients at early to moderate disease stage, but was less pronounced in all segments. iRBD patients also had signifi-cantly fewer propulsive colon movements compared to HC (p<0.05).

Conclusions: Using objective measures, the present study shows that intestinal function is affected in iRBD patients, although not as markedly as seen in diagnosed PD patients. This difference could be due to additional effects of dopaminergic medication on GI motility. Nevertheless, our study supports that the GI tract is significantly affected at the early prodromal phase of RBD-positive PD/DLB patients.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/objective-intestinal-dysfunction-in-rem-sleep-behaviour-disorder/