As shown in the present results, there were no differences in the use of dopaminergic agents expressed as the levodopa equivalent daily dose between PD with GERD and without GERD, which indicates that dopaminergic agents are not directly linked to the development of GERD. There are research data indicating the relationship between spinal kyphosis associated with osteoporosis and GERD in elderly people [16-18]. Postural abnormalities of the trunk are also frequent in PD patients . The bent forward postural abnormality, known as camptocormia, is one such trunk abnormality that occurs in PD patients .
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].
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.
Helicobacter pylori (H. pylori) infection can induce motor fluctuations by interrupting the absorption of levodopa in PD patients [26-29]. Eradication of H.
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.
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.
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.
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.
Finally, we performed multiple logistic regression analysis of PD with or without GERD. In the analysis, we used â€œ1â€ to represent PD with GERD, males, and patients with the wearing-off phenomenon and â€œ0â€ to represent PD without GERD, females, and patients without the wearing-off phenomenon. The other parameters were represented by their original values. The etiology of GERD still remains unclear; however, pathological research has provided some suggestive findings regarding the alimentary system. Lewy bodies in the extra central nervous system have been reported in Auerbachâ€™s and Meissnerâ€™s plexuses by systemic pathological examination .
- Treatment of esophageal problems in PD still remains difficult.
- Finally, we performed multiple logistic regression analysis of PD with or without GERD.
- As a therapeutic diagnostic method, 24â€‰h esophageal pH monitoring combined with the PPI test  is also used.
- Although Lewy bodies in the alimentary system have been reported in autopsy cases with megacolon and achalasia [13-15], there is no direct evidence of the association between GERD and the lower esophageal Lewy bodies.
- 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.
Our patient-control study suggested that GERD, as defined by the FSSG score, was more prevalent in PD patients than in the healthy controls. The prevalence rate was 26.5%. The presence of PD increased the prevalence rate of GERD to 4.1 times higher than that of the age-matched controls. These findings indicated that PD can be a risk factor of GERD.
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.
Nonmotor symptoms are troublesome for PD patients and physicians because conventional dopaminergic therapy does not always work efficiently in the management of these symptoms. Therefore, physicians should be alert for treatable symptoms. The diagnosis of GERD is commonly based on the history or findings from upper gastrointestinal endoscopy. As a therapeutic diagnostic method, 24â€‰h esophageal pH monitoring combined with the PPI test  is also used. Because clinical history-based diagnosis is the simplest and quickest, demanding no additional workload of the patients, it is suitable for clinical practice.
The results of the analysis comparing between PD with and without GERD suggested that GERD was clinically characterized by subjective heartburn and was more common in the advanced stage presenting with the wearing-off phenomenon. The analysis also suggested that GERD could cause deterioration of patientsâ€™ daily living activities and quality of life and that GERD was associated with the presence of other nonmotor symptoms. Furthermore, daily living activity and nonmotor symptoms can be independent relating factors of GERD in PD. These results suggest that GERD is a frequent nonmotor problem and a deteriorating factor of daily living activity in PD patients.
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.
Patients were consecutively recruited from the outpatient clinic of neurology at the Research Institute for Brain and Blood Vessels, from October 2010 to September 2011. The patients had to fulfill the criteria of the United Kingdom PD Brain Bank .