Variable symptoms in the alimentary system from the mouth to the anorectum have been reported . Gastrointestinal problems are also a type of nonmotor symptoms. All parts of the gastrointestinal tract can be affected, even in the earlier phase of the disease course in some cases.
Symptoms of autonomic dysfunction can impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient.
Because clinical symptoms of GERD are treatable, efforts to recognize the presence of GERD should be made to preserve the quality of life of PD patients. However, there remains a certain limitation to interpret the results. We cannot exclude the possibility that our results were peculiar to the outpatient. The aim of this study is to investigate the frequency and clinical features of gastroesophageal reflex disease (GERD) in Parkinsonâ€™s disease (PD). Consecutively recruited PD patients and controls were questioned about heartburn and GERD with a questionnaire.
This study suggests that GERD is prevalent in PD. Deterioration of daily living activities and other nonmotor symptoms can imply the presence of GERD. Because clinical symptoms of GERD are usually treatable, the management can improve the patientâ€™s quality of life.
In clinical practice, disappearance of these symptoms following treatment with proton pump inhibitors (PPIs) allows general physicians to reasonably conclude that the patient had acid-related dyspepsia . Dyspepsia is usually defined as upper abdominal pain or retrosternal pain, discomfort, heartburn, nausea, vomiting, or other symptoms considered to arise from the upper alimentary tract. When these symptoms cause deterioration of patientsâ€™ daily life quality, PPIs are generally used for treatment because they are more effective than histamine H2 receptor antagonists for reflux-like (heartburn) or ulcer-like (episodic epigastric pain) dyspepsia.
The lower esophagus is one of the extra central nervous organs that share Lewy bodies, which are frequently found in Auerbachâ€™s plexus. Pathological abnormalities may induce variable degrees of functional disorders in the lower esophagus.
Healthy controls were also consecutively recruited. All the patients and controls were interviewed and neurologically examined and then confirmed as having no systemic or neurological disorder. Written informed consent to participate in this study was obtained from all the participants. In this study, we investigated the frequency and clinical features of GERD in PD.
pylori can improve these annoying problems in H. pylori-infected PD patients. However, it is unpredictable whether H. pylori eradication is helpful for improving symptoms of GERD in PD patients because the effect of eradication is still controversial in patients with GERD [30-32].
Unlike NVP, symptoms may persist well into the second or third trimesters due to the enlarging uterus and displacement of the intra-abdominal organs and lower esophageal sphincter. Comanagement of NVP and reflux is often necessary in order to maximize treatment benefit. The aim of this chapter is to present the clinical presentation; diagnosis and management strategies of NVP, HG, and reflux; and the more infrequent occurrence of ptyalism in pregnancy. Although extrapyramidal diseases are commonly thought to solely affect the (extrapyramidal) motor system, non-motor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction is an important clinical component of extrapyramidal disease, but it is often not formally assessed, and thus frequently misdiagnosed.
The prevalence rate varies from 3% to 17.6% [19, 21-24]. We defined patients who had this postural abnormality, regardless of the degree of thoracolumbar flexion, and also complained of distress in their daily life because of the abnormal posture as having bent forward flexion because there are no unified and confirmed diagnostic criteria for abnormal posture in PD. In our study, the prevalence rate of bent forward flexion using this definition was relatively frequent compared with that in previous reports. test. Following this, we compared clinical characteristics of PD with or without GERD and examined the correlation of these characteristics with FSSG scores using Spearmanâ€™s rank correlation coefficient.
Although PD is still the most well-known movement disorder, growing recognition of variable nonmotor symptoms suggests that PD is a systemic disease. Nonmotor symptoms of PD are a major cause of disability for PD patients, and recognition and treatment of nonmotor symptoms are important to maintain comprehensive healthcare for PD patients [3, 10, 11].
FSSG was created in Japan for physicians, including general practitioners, to not only assist in the initial diagnosis of GERD, but also allow quantitative assessment of the effects of treatment and the changes in symptoms over time . A significant reduction in the FSSG score occurs in patients with both mild and severe GERD after therapy with PPI . FSSG contains the 12 symptoms most commonly experienced by GERD patients, with 7 being reflux symptoms and the remaining 5 being dyspeptic symptoms. When the total score is more than 8, GERD can be diagnosed with 62% sensitivity and 59% specificity.
Dopaminergic agents induce gastrointestinal problems by stimulating the peripheral dopaminergic receptors, which are mainly induced as nausea. A clinical review that has described adverse effects of dopaminergic agonists has addressed nausea as a popular adverse effect in the early stage of PD patients, whereas GERD or gastroesophageal influx has not been mentioned . Although nausea is a common clinical symptom of GERD, there is no evidence that nausea leads to GERD.
Dysphagia is relatively common and observed in 29%-80% of PD patients [2, 3], which can be induced by dyscoordination of various organs such as the mouth, pharynx, and esophagus. In addition to abnormalities of esophageal peristalsis, dysfunction in the lower esophageal sphincter can also produce clinical symptoms of gastroesophageal reflux [4-6]. Treatment of esophageal problems in PD still remains difficult. However, symptoms derived from gastroesophageal reflux can be treated with appropriate antireflux measures.