Gastrointestinal dysfunction in movement disorders

Purpose of review This article provides an overview of the clinical presentation, investigations, and treatment options for gastrointestinal tract (GIT) dysfunction in patients with Parkinson's disease (PD) and other movement disorders. Recent findings GIT dysfunction commonly appears as constipation and fecal incontinence (mostly overflow, accompanied with sphincter failure in multiple system atrophy [MSA]). Bowel dysfunction (underactive) occurs irrespectively from the site of the neurologic lesion, which is in contrast to site-dependent bladder dysfunction (brain, overactive; periphery, underactive). GI emergencies may arise, including intestinal pseudo-obstruction, intussusception, volvulus, and stercoral ulcer (ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation). Bowel function tests in neurologic patients often show a combination of slow transit and anorectal dysfunction. Management for slow transit constipation includes bulking agents, softening agents, yogurt/probiotics, and prokinetic agents. Suppositories, botulinum toxin injections, and transanal irrigation are options for managing anorectal constipation. Conclusions Function of the bowel is commonly affected in PD and other movement disorders. Neurologists play an important role in assessing bowel symptoms in their patients and planning treatment strategies, often in collaboration with specialist teams.

Automated summary

This article provides an overview of gastrointestinal tract dysfunction in patients with Parkinson's disease and other movement disorders, including clinical presentation, investigations, and treatment options. Bowel dysfunction is common in these patients and may present as constipation, fecal incontinence, and GI emergencies such as intestinal pseudo-obstruction and volvulus. Management options include bulking agents, softening agents, probiotics, and specialized procedures like botulinum toxin injections.