Management of dysphagia and gastroparesis in Parkinson's disease in real-world clinical practice - Balancing pharmacological and non-pharmacological approaches.

Gastrointestinal (GI) issues are commonly experienced by patients with Parkinson's disease (PD). Those that affect the lower GI tract, such as constipation, are the most frequently reported GI problems among patients with PD. Upper GI issues, such as swallowing dysfunction (dysphagia) and delayed gastric emptying (gastroparesis), are also common in PD but are less well recognized by both patients and clinicians and, therefore, often overlooked. These GI issues may also be perceived by the healthcare team as less of a priority than management of PD motor symptoms. However, if left untreated, both dysphagia and gastroparesis can have a significant impact on the quality of life of patients with PD and on the effectiveness on oral PD medications, with negative consequences for motor control. Holistic management of PD should therefore include timely and effective management of upper GI issues by utilizing both non-pharmacological and pharmacological approaches. This dual approach is key as many pharmacological strategies have limited efficacy in this setting, so non-pharmacological approaches are often the best option. Although a multidisciplinary approach to the management of GI issues in PD is ideal, resource constraints may mean this is not always feasible. In 'real-world' practice, neurologists and PD care teams often need to make initial assessments and treatment or referral recommendations for their patients with PD who are experiencing these problems. To provide guidance in these cases, this article reviews the published evidence for diagnostic and therapeutic management of dysphagia and gastroparesis, including recommendations for timely and appropriate referral to GI specialists when needed and guidance on the development of an effective management plan.

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Copyright © 2022 Bhidayasiri, Phuenpathom, Tan, Leta, Phumphid, Chaudhuri and Pal.

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Author RB received consultancy and/or honoraria/lecture fees from Abbott, Boehringer Ingelheim, Britannia, Ipsen, Novartis, Teva-Lundbeck, Takeda, and Otsuka Pharmaceutical; he has received research funding from the Newton Fund, the UK Government, Thailand Science and Research Innovation Bureau, Thailand Research Fund, Crown Property Bureau, Chulalongkorn University, and the National Science and Technology Development Agency; he holds patents for laser-guided walking stick, portable tremor device, nocturnal monitoring, and electronic Parkinson’s disease symptom diary as well as copyright on dopamine lyrics and teaching video clips for common nocturnal and gastrointestinal symptoms for Parkinson’s disease. Author WP was supported by The Second Century Fund (C2F), Chulalongkorn University. Author AT received research funding from The Michael J. Fox Foundation, the Toray Science Foundation, and the Malaysian Ministry of Education Fundamental Research Grant Scheme. Author VL received grants from NIHR BRC, Parkinson’s UK, travel and congress grants from Bial Pharma UK Ltd., speaker-related activity fees from Britannia Pharmaceuticals, Bial Pharma UK, Profile, and consultancy fees from Invisio Pharmaceuticals and Bial Pharma UK, all outside the submitted work. Author KC served as an advisory board member of AbbVie, UCB, GKC, Bial, Cynapsus, Lobsor, Stada, Zambon, Profile Pharma, Synovion, Roche, Theravance, Scion, Britannia, Acadia, 4D Pharma, has received speaker-related activity fees from AbbVie, Britannia, UCB, Zambon, Novartis, Boehringer Ingelheim, Bial, Kyowa Kirin, SK Pharma, research grant from Bial Pharma UK, and royalties from Oxford (book), Cambridge publishers (book), MAPI institute (KPPS, PDSS 2). Author PP received honoraria for delivering lectures in teaching programs conducted by International Parkinson Disease and Movement Disorders Society (MDS). He has received research funding from Indian Council of Medical Research (ICMR), Department of Biotechnology (DBT), Department of Science and Technology-Cognitive Science Research Initiative (DST-CSRI), Department of Science and Technology-Science and Engineering Research Board (DST-SERB), Michael J. Fox Foundation (United States), and Scientific Knowledge for Ageing and Neurological ailments (SKAN). The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.