Digestion problems like constipation or difficulty in swallowing can double the chance of Parkinson’s disease, according to a recent study, which suggested that four gut conditions could be an early warning of the disease.
The origins of Alzheimer’s disease, strokes and brain aneurysms have been linked to the gastrointestinal tract, but while there is evidence Parkinson’s could also begin in the gut, there have been few studies of its relationship to particular digestive disorders, reports The Guardian.
The latest research, however, “is the first to establish substantial observational evidence” that a clinical diagnosis of gut issues “might specifically predict the development of Parkinson’s disease”, the authors conclude.
The study, led by Mayo Clinic Arizona scientists, compared the medical records of 24 624 people in the US with Parkinson’s, 19 046 people with Alzheimer’s and 23 942 people with cerebrovascular disease.
Those with Parkinson’s were matched with patients in the other groups for age, sex, race and ethnicity, and length of diagnosis to compare the frequency of gastrointestinal conditions in the six years before diagnosis.
They also compared the medical records of everyone in the study diagnosed with any of 18 gut conditions to those without that particular condition over five years to see how many of them developed Parkinson’s disease or other neurological disorders.
Both comparisons found a higher risk of a Parkinson’s disease diagnosis for patients with gut issues. Those with constipation, difficulty swallowing (dysphagia) and gastroparesis, where food takes longer to move from the stomach into the small intestine, were more than twice as likely to develop Parkinson’s disease in the five years before diagnosis, while IBS without diarrhoea was associated with a 17% higher risk.
Some gastrointestinal symptoms, including functional dyspepsia (burning sensation or fullness of the stomach with no obvious cause), IBS with diarrhoea, and diarrhoea plus faecal incontinence, were found to be more common among patients who developed Parkinson’s disease too.
But they were also more common before the onset of Alzheimer’s disease, aneurysms or strokes.
However, other gut issues such as inflammatory bowel disease did not increase the likelihood of developing Parkinson’s, the study found.
And patients who had their appendix removed were less likely to develop Parkinson’s, the authors calculated.
They added that the findings – published in The BMJ Gut – “warrant alertness” for gut issues in those patients at higher risk of Parkinson’s disease and call for further investigation of the links between gastrointestinal conditions and Alzheimer’s, strokes and aneurysms.
According to the WHO, around 8. 5m people worldwide have the disease.
Kim Barrett, vice-dean for research at the University of California-Davis, said that it may be important for doctors to “take note” of these gut conditions when evaluating patients at risk for Parkinson’s, “even before the onset of neurological symptoms”, but she urged caution.
“The findings are purely correlative, and it remains possible that both gastrointestinal conditions and Parkinson’s disease are independently linked to an as yet unknown third risk factor.”
Study details
Gastrointestinal syndromes preceding a diagnosis of Parkinson’s disease: testing Braak’s hypothesis using a nationwide database for comparison with Alzheimer’s disease and cerebrovascular diseases
Bo Konings, Luisa Villatoro, , Robert Burns, Pankaj Jay Pasricha, et al.
Published in The BMJ Gut in August 2023
Abstract
Objective
Braak’s hypothesis states that Parkinson’s disease (PD) originates in the gastrointestinal (GI) tract, and similar associations have been established for Alzheimer’s disease (AD) and cerebrovascular diseases (CVD). We aimed to determine the incidence of GI syndromes and interventions preceding PD compared with negative controls (NCs), AD and CVD.
Design
We performed a combined case-control and cohort study using TriNetX, a US based nationwide medical record network. Firstly, we compared subjects with new onset idiopathic PD with matched NCs and patients with contemporary diagnoses of AD and CVD, to investigate preceding GI syndromes, appendectomy and vagotomy. Secondly, we compared cohorts with these exposures to matched NCs for the development of PD, AD and CVD within 5 years.
Results
We identified 24 624 PD patients in the case-control analysis and matched 18 cohorts with each exposure to their NCs. Gastroparesis, dysphagia, irritable bowel syndrome (IBS) without diarrhoea and constipation showed specific associations with PD (vs NCs, AD and CVD) in both the case-control (odds ratios (ORs) vs NCs 4.64, 3.58, 3.53 and 3.32, respectively, all p<0.0001) and cohort analyses (relative risks (RRs) vs NCs 2.43, 2.27, 1.17 and 2.38, respectively, all p<0.05). While functional dyspepsia, IBS with diarrhoea, diarrhoea and faecal incontinence were not PD specific, IBS with constipation and intestinal pseudo-obstruction showed PD specificity in the case-control (OR 4.11) and cohort analysis (RR 1.84), respectively. Appendectomy decreased the risk of PD in the cohort analysis (RR 0.48). Neither inflammatory bowel disease nor vagotomy were associated with PD.
Conclusion
Dysphagia, gastroparesis, IBS without diarrhoea and constipation might specifically predict Parkinson’s disease.
See more from MedicalBrief archives:
Link between appendix removal and development of Parkinson's
Visual dysfunction predicts Parkinson’s-linked cognitive decline 18 months ahead
Inflammatory bowel disease linked to doubled dementia risk in nationwide study
Prostate drug associated with lower risk of Parkinson’s — large international analysis