Gastrointestinal and Urinary Dysfunction

This post is of interest to those dealing with gastrointestinal problems, urinary dysfunction, problems with saliva, dysphagia, etc.

This article on gastrointestinal and urinary dysfunction in PD was published today in PDF News.  PDF = Parkinson’s Disease Foundation.  The author is Dr. Ron Pfeiffer, the same neurologist who spoke on non-motor symptoms at last year’s PD Symposium in the Bay Area.

Here’s a  link to the article online:

Gastrointestinal and Urinary Dysfunction in PD
By Dr. Ronald Pfeiffer
PDF News, Spring 2007

I’ve copied a few excerpts below on dysphagia and stomach problems.



Excerpts from:

Gastrointestinal and Urinary Dysfunction in PD
By Dr. Ronald Pfeiffer
PDF News, Spring 2007

Difficulty swallowing, or dysphagia, is a very common problem in Parkinson’s.  At least 50 percent (some studies even suggest over 80 percent) of people with PD experience difficulty in swallowing, and an even greater percentage show abnormalities on x-ray tests of swallowing.

Difficulty swallowing is usually due to the lack of coordination among the many muscles in the mouth and throat that must work together in perfect precision to produce normal swallowing.  When food gets stuck in the mouth, the person may have to try several times to complete a swallow.  The muscles in the back of the throat — and in the esophagus — may also lose coordination, and individuals who have difficulty swallowing are at increased risk for food or liquid to get into the windpipe.  From there, it can get into the lungs (called aspiration), which can result in pneumonia.

Although treatment of dysphagia can be difficult, speech/swallowing therapists can instruct patients on swallowing techniques and on designing changes in food consistency that reduce the risk of aspiration.  Some improvement in coordination of the muscles used in swallowing may be achieved through adjustments in PD medications.  Only very rarely is it necessary to place a feeding tube.

Stomach problems
Impaired ability to empty the contents of the stomach, called gastroparesis, is another potential gastrointestinal complication of PD.  This may produce a bloated sensation and cause people to feel full even though they have eaten very little.  Sometimes nausea may develop.

Failure of the stomach to empty in a timely fashion may also impair or delay the effectiveness of PD medications, especially levodopa, since levodopa is absorbed from the small intestine and cannot get to its destination if it is trapped in the stomach.
Treatment of gastroparesis in Parkinson’s has not been extensively studied.  Domperidone is an effective medication, but unfortunately it is not available in the US.

Treatment routes that bypass the stomach, such as transdermal drug delivery by skin patch, may become available in the near future.  Another potential treatment under investigation involves a form of levodopa designed to be delivered directly into the small intestine via a feeding tube.