Consensus practice recommendations for management of gastrointestinal dysfunction in Parkinson disease

• Published in: Parkinsonism & related disorders 2024-07, Vol.124, p.106982, Article 106982
• Main Authors: Safarpour, Delaram, Stover, Natividad, Shprecher, David R., Hamedani, Ali G., Pfeiffer, Ronald F., Parkman, Henry P., Quigley, Eamonn MM, Cloud, Leslie J.
• Format: Article
• Language: English
• Subjects: Consensus recommendation; Constipation; Drooling; Gastric emptying delay; Gastrointestinal dysfunction; Parkinson disease; Parkinson's disease; Small intestinal bacterial overgrowth; Swallowing dysfunction
• ISSN: 1353-8020; 1873-5126; 1873-5126
• DOI: 10.1016/j.parkreldis.2024.106982

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. To develop consensus statements on screening, diagnosis, and treatment of GI dysfunction in PD. 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. 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. These consensus recommendations offer a practical framework for the diagnosis and treatment of GI dysfunction in PD. •Maintain vigilance with screening for GI symptoms at regular follow-up visits across all disease stages.•Consider the impact of PD motor medications (and non-PD medications) on GI symptoms.•A multidisciplinary approach to GI dysfunction in PD is the ideal practice.•Refer to gastroenterology for esophageal dysphagia, persistent bothersome symptoms that are refractory to initial interventions or accompanied by red flags.