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Colonic transit, high-resolution anorectal manometry and MRI defecography study of constipation in Parkinson's disease.
Parkinsonism Relat Disord. 2019 09; 66:195-201.PR

Abstract

INTRODUCTION

Despite clinical relevance and potential role on the disease pathogenesis, underlying mechanisms of constipation in Parkinson's disease (PD) remain poorly understood. A systematic assessment using complementary physiological investigations was performed to elucidate constipation pathophysiology in order to improve its symptomatic management.

METHODS

PD patients with constipation were evaluated with clinical questionnaires, colonic transit, high-resolution anorectal manometry and MRI defecography. Results were compared and correlated with clinical features.

RESULTS

A total of 42 patients (69% male; age 68 ± 8 years; disease duration 10.5 ± 6.1 years) were included, of whom 33 (78.6%) had objective constipation defined by < 3 bowel movements per week or straining. Severity of constipation measured by self-administered questionnaires correlated with disease severity, burden of motor and non-motor symptoms but not with age, disease duration or Parkinson's medications. Colonic transit and anorectal function (high-resolution anorectal manometry and/or MRI defecography) was assessed in 15 patients. A combination of both delayed colonic transit and anorectal dysfunction was the pattern most commonly found (60% of patients) and overall anorectal dysfunction was more prevalent than isolated slow transit constipation. Physiological findings were heterogeneous including reduced colonic motility, rectal hyposensitivity, defecatory dyssynergia and poor motor rectal function.

CONCLUSION

Subjective constipation in PD is poorly correlated with commonly used definition, assessment questionnaires and physiological results. Multiple complex overlapping pathophysiological mechanisms are responsible including slow transit and anorectal dysfunction. Complementary investigations to assess colonic transit and anorectal function are required in those with refractory symptoms for a systematic assessment and appropriate symptomatic management.

Authors+Show Affiliations

Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, United Kingdom; Queen Square Brain Bank for Neurological Disorders, University College London Queen Square Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, United Kingdom. Electronic address: eduardo.fernandez.13@ucl.ac.uk.Gastrointestinal Physiology Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom. Electronic address: v.passananti@nhs.net.Gastrointestinal Physiology Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom. Electronic address: n.zarate-lopez@nhs.net.Gastrointestinal Physiology Unit, University College London Hospital, 235 Euston Road, London, NW1 2BU, United Kingdom. Electronic address: a.emmanuel@ucl.ac.uk.Reta Lila Weston Institute of Neurological Studies, University College London Queen Square Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, United Kingdom; Queen Square Brain Bank for Neurological Disorders, University College London Queen Square Institute of Neurology, 1 Wakefield Street, London, WC1N 1PJ, United Kingdom. Electronic address: t.warner@ucl.ac.uk.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31473084

Citation

De Pablo-Fernández, Eduardo, et al. "Colonic Transit, High-resolution Anorectal Manometry and MRI Defecography Study of Constipation in Parkinson's Disease." Parkinsonism & Related Disorders, vol. 66, 2019, pp. 195-201.
De Pablo-Fernández E, Passananti V, Zárate-López N, et al. Colonic transit, high-resolution anorectal manometry and MRI defecography study of constipation in Parkinson's disease. Parkinsonism Relat Disord. 2019;66:195-201.
De Pablo-Fernández, E., Passananti, V., Zárate-López, N., Emmanuel, A., & Warner, T. (2019). Colonic transit, high-resolution anorectal manometry and MRI defecography study of constipation in Parkinson's disease. Parkinsonism & Related Disorders, 66, 195-201. https://doi.org/10.1016/j.parkreldis.2019.08.016
De Pablo-Fernández E, et al. Colonic Transit, High-resolution Anorectal Manometry and MRI Defecography Study of Constipation in Parkinson's Disease. Parkinsonism Relat Disord. 2019;66:195-201. PubMed PMID: 31473084.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Colonic transit, high-resolution anorectal manometry and MRI defecography study of constipation in Parkinson's disease. AU - De Pablo-Fernández,Eduardo, AU - Passananti,Valentina, AU - Zárate-López,Natalia, AU - Emmanuel,Anton, AU - Warner,Thomas, Y1 - 2019/08/28/ PY - 2019/01/31/received PY - 2019/08/27/revised PY - 2019/08/27/accepted PY - 2019/9/2/pubmed PY - 2020/8/5/medline PY - 2019/9/2/entrez KW - Anorectal dysfunction KW - Colonic transit KW - Constipation KW - Manometry KW - Parkinson's disease SP - 195 EP - 201 JF - Parkinsonism & related disorders JO - Parkinsonism Relat. Disord. VL - 66 N2 - INTRODUCTION: Despite clinical relevance and potential role on the disease pathogenesis, underlying mechanisms of constipation in Parkinson's disease (PD) remain poorly understood. A systematic assessment using complementary physiological investigations was performed to elucidate constipation pathophysiology in order to improve its symptomatic management. METHODS: PD patients with constipation were evaluated with clinical questionnaires, colonic transit, high-resolution anorectal manometry and MRI defecography. Results were compared and correlated with clinical features. RESULTS: A total of 42 patients (69% male; age 68 ± 8 years; disease duration 10.5 ± 6.1 years) were included, of whom 33 (78.6%) had objective constipation defined by < 3 bowel movements per week or straining. Severity of constipation measured by self-administered questionnaires correlated with disease severity, burden of motor and non-motor symptoms but not with age, disease duration or Parkinson's medications. Colonic transit and anorectal function (high-resolution anorectal manometry and/or MRI defecography) was assessed in 15 patients. A combination of both delayed colonic transit and anorectal dysfunction was the pattern most commonly found (60% of patients) and overall anorectal dysfunction was more prevalent than isolated slow transit constipation. Physiological findings were heterogeneous including reduced colonic motility, rectal hyposensitivity, defecatory dyssynergia and poor motor rectal function. CONCLUSION: Subjective constipation in PD is poorly correlated with commonly used definition, assessment questionnaires and physiological results. Multiple complex overlapping pathophysiological mechanisms are responsible including slow transit and anorectal dysfunction. Complementary investigations to assess colonic transit and anorectal function are required in those with refractory symptoms for a systematic assessment and appropriate symptomatic management. SN - 1873-5126 UR - https://www.unboundmedicine.com/medline/citation/31473084/Colonic_transit_high_resolution_anorectal_manometry_and_MRI_defecography_study_of_constipation_in_Parkinson's_disease_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1353-8020(19)30372-4 DB - PRIME DP - Unbound Medicine ER -