Consensus practice recommendations for management of gastrointestinal dysfunction in Parkinson disease

Delaram Safarpour; Natividad Stover; David R Shprecher; Ali G Hamedani; Ronald F Pfeiffer; Henry P Parkman; Eamonn Mm Quigley; Leslie J Cloud; Other Non-motor Features Working Group of the Parkinson Study Group

doi:10.1016/j.parkreldis.2024.106982

Consensus practice recommendations for management of gastrointestinal dysfunction in Parkinson disease

Parkinsonism Relat Disord. 2024 May 3:106982. doi: 10.1016/j.parkreldis.2024.106982. Online ahead of print.

Authors

Delaram Safarpour¹, Natividad Stover², David R Shprecher³, Ali G Hamedani⁴, Ronald F Pfeiffer⁵, Henry P Parkman⁶, Eamonn Mm Quigley⁷, Leslie J Cloud⁸; Other Non-motor Features Working Group of the Parkinson Study Group

Affiliations

¹ Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA. Electronic address: safarpou@ohsu.edu.
² Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
³ Banner Sun Health Research Institute, Sun City, AZ, USA.
⁴ Departments of Neurology, Ophthalmology, and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁵ Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, OR, USA.
⁶ Section of Gastroenterology, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA.
⁷ Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital and Weill Cornell Medical College, Houston, TX, USA.
⁸ Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.

PMID: 38729797
DOI: 10.1016/j.parkreldis.2024.106982

Abstract

Background: Gastrointestinal (GI) dysfunction is a common non-motor feature of Parkinson disease (PD). GI symptoms may start years before the onset of motor symptoms and impair quality of life. Robust clinical trial data is lacking to guide screening, diagnosis and treatment of GI dysfunction in PD.

Objective: To develop consensus statements on screening, diagnosis, and treatment of GI dysfunction in PD.

Methods: The application of a modified Delphi panel allowed for the synthesis of expert opinions into clinical statements. Consensus was predefined as a level of agreement of 100 % for each item. Five virtual Delphi rounds were held. Two movement disorders neurologists reviewed the literature on GI dysfunction in PD and developed draft statements based on the literature review. Draft statements were distributed among the panel that included five movement disorder neurologists and two gastroenterologists, both experts in GI dysmotility and its impact on PD symptoms. All members reviewed the statements and references in advance of the virtual meetings. In the virtual meetings, each statement was discussed, edited, and a vote was conducted. If there was not 100 % consensus, further discussions and modifications ensued until there was consensus.

Results: Statements were developed for screening, diagnosis, and treatment of common GI symptoms in PD and were organized by anatomic segments: oral cavity and esophagus, stomach, small intestine, and colon and anorectum.

Conclusions: These consensus recommendations offer a practical framework for the diagnosis and treatment of GI dysfunction in PD.

Keywords: Consensus recommendation; Constipation; Drooling; Gastric emptying delay; Gastrointestinal dysfunction; Parkinson disease; Parkinson's disease; Small intestinal bacterial overgrowth; Swallowing dysfunction.

Publication types

Review