The Parkinson's Institute and Clinical Center

The Parkinson's Institute and Clinical Center is using its 2017 distribution to fund:

Continuation of a two-Year Prospective Longitudinal Study using Quantitative and Qualitative Assessments to Define the Natural History of Gastrointestinal Symptoms in Patients with Parkinson’s Disease or at Risk for Developing the Motor Symptoms of Parkinson’s Disease

PROJECT TITLE:  Continuation of a two-Year Prospective Longitudinal Study using Quantitative and Qualitative Assessments to Define the Natural History of Gastrointestinal Symptoms in Patients with Parkinson’s Disease or at Risk for Developing the Motor Symptoms of Parkinson’s Disease

Investigator/Author:  C. Barlow PI, G. Triadafilopoulos co-PI, J.W. Langston co-PI, L. Rees co-PI, R. Gandhy co-PI, S. Brillman co-PI, B. Schuele co-PI

Objective: To characterize the natural progression of gastrointestinal symptoms in patients with Parkinson’s disease, or who are at high risk for developing the motor symptoms of Parkinson’s disease, using the Gastrointestinal Symptom Relief Scale (GSRS) and Gastroparesis Cardinal Symptom Index (GCSI); high resolution esophageal manometry to evaluate the functioning of the esophageal muscle and sphincters; high resolution anorectal manometry to evaluate anorectal motility and coordination; and the SmartPill® to measure gastric, colon, and small bowel transit times.

Background: This project is ongoing and in 2017 we presented the first set of data on the esophageal findings at the Movement Disorder Meeting in Portland by Dr. Salima Brillman. The Parkinson Alliance/Parkinson’s Unity Walk was acknowledged on the poster. Dysphagia is common in Parkinson’s disease; its etiology multifactorial and its management challenging. In a retrospective cohort analysis, we aimed to objectively characterize dysphagia and/or other esophageal symptoms in Parkinson’s disease, assess the prevalence of outflow obstruction, disorders of esophageal peristalsis leading to impaired esophageal clearance and highlight objective parameters that can help in current management. In a prospective cohort of Parkinson’s disease patients, we evaluated the intrapersonal variability of these esophageal motility findings in patients with various disease stages and with or without esophageal symptoms.

Methods/Design: This is a single center, prospective, non-interventional, cross-sectional and longitudinal study of the natural history of gastrointestinal symptoms associated with Parkinson’s disease.  Data from this study will be used to characterize the progression of gastrointestinal symptoms associated with Parkinson’s disease and determine which outcome measures will be best to assess the efficacy of future potential therapies and to optimize ongoing patient management.

Relevance to Diagnosis/Treatment of Parkinson’s disease: Quantitative assessments may be able to demonstrate improvement or worsening of gastrointestinal dysfunction in relation to changes in medication and therefore be better for diagnosis of gastrointestinal issues and for following response to treatment. Analysis of the gastrointestinal tract may also lead to earlier diagnosis of Parkinson’s disease, quicker referral to specialty centers and improved patient care and patient outcomes.

September 2018 Project Update:

This project is ongoing and in 2018-2019 we anticipate that we will complete the first set of data analysis.  Critically, we have several patients who have completed their 2-year study period and we have expanded the study to 5 years. Our paper, “Pilot cohort study of endoscopic botulinum neurotoxin injection in Parkinson’s Disease” George Triadafilopoulos, MD, Rita Gandhy, MD, Carrolee Barlow, MD, PhD which describes our work using Botox to treat the complications of enteric nervous system dysfunction in Parkinson’s was accepted and is now published in Parkinsonism and Related Disorders Journal with the title of Pilot cohort study of endoscopic botulinum neurotoxin injection in Parkinson's disease.