Semin Neurol 2023; 43(04): 562-571
DOI: 10.1055/s-0043-1771457
Review Article

Constipation in Parkinson's Disease

Eamonn M. M. Quigley
1   Division of Gastroenterology and Hepatology, Lynda K and David M Underwood Center for Digestive Disorders, Houston Methodist Hospital, Houston, Texas
› Author Affiliations

Abstract

Constipation is one of the most common gastrointestinal features of Parkinson's disease (PD), occurring in over 50% of all PD patients during the course of their disease. Furthermore, constipation is now recognized as an important, prodromal symptom and may predate the onset of the classical motor symptoms by decades. Thereafter, the prevalence and severity of constipation in PD tend to parallel the course of both motor and nonmotor phenomena such as cognitive decline and depression. Difficult defecation (obstructed defecation, dyssynergia) is the primary pathophysiology underlying constipation and likely reflects involvement by the PD process of one or more of the many skeletal muscle groups that are involved in effecting defecation. Management of constipation in PD may be complicated by several patient factors including dysphagia, cognitive impairment, depression, and weak sphincter tone. While the armamentarium available to those who treat constipation, in general, has expanded considerably in recent years, the evidence supporting any therapy in the management of this symptom in PD has remained slim.



Publication History

Article published online:
14 August 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Sanchez MI, Bercik P. Epidemiology and burden of chronic constipation. Can J Gastroenterol 2011; 25 (Suppl B, Suppl B): 11B-15B
  • 2 Gallegos-Orozco JF, Foxx-Orenstein AE, Sterler SM, Stoa JM. Chronic constipation in the elderly. Am J Gastroenterol 2012; 107 (01) 18-25 , quiz 26
  • 3 Sperber AD, Bangdiwala SI, Drossman DA. et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome Foundation Global Study. Gastroenterology 2021; 160 (01) 99-114.e3
  • 4 Johanson JF, Kralstein J. Chronic constipation: a survey of the patient perspective. Aliment Pharmacol Ther 2007; 25 (05) 599-608
  • 5 Lacy BE, Mearin F, Chang L. et al. Bowel disorders. Gastroenterology 2016 S0016-5085(16)00222-5. (e-pub ahead of print).
  • 6 Wald A, Sigurdsson L. Quality of life in children and adults with constipation. Best Pract Res Clin Gastroenterol 2011; 25 (01) 19-27
  • 7 Mason HJ, Serrano-Ikkos E, Kamm MA. Psychological morbidity in women with idiopathic constipation. Am J Gastroenterol 2000; 95 (10) 2852-2857
  • 8 Faigel DO. A clinical approach to constipation. Clin Cornerstone 2002; 4 (04) 11-21
  • 9 Wald A, Scarpignato C, Mueller-Lissner S. et al. A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation. Aliment Pharmacol Ther 2008; 28 (07) 917-930
  • 10 Wald A, Mueller-Lissner S, Kamm MA. et al. Survey of laxative use by adults with self-defined constipation in South America and Asia: a comparison of six countries. Aliment Pharmacol Ther 2010; 31 (02) 274-284
  • 11 Koch A, Voderholzer WA, Klauser AG, Müller-Lissner S. Symptoms in chronic constipation. Dis Colon Rectum 1997; 40 (08) 902-906
  • 12 Gallagher PF, O'Mahony D, Quigley EMM. Management of chronic constipation in the elderly. Drugs Aging 2008; 25 (10) 807-821
  • 13 Eadie MJ, Tyrer JH. Alimentary disorder in parkinsonism. Australas Ann Med 1965; 14: 13-22
  • 14 Pfeiffer RF. Gastrointestinal dysfunction in Parkinson's disease. Lancet Neurol 2003; 2 (02) 107-116
  • 15 Chaudhuri KR, Healy DG, Schapira AH. National Institute for Clinical Excellence. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurol 2006; 5 (03) 235-245
  • 16 Edwards LL, Quigley EMM, Pfeiffer RF. Gastrointestinal dysfunction in Parkinson's disease: frequency and pathophysiology. Neurology 1992; 42 (04) 726-732
  • 17 Edwards L, Quigley EMM, Hofman R, Pfeiffer RF. Gastrointestinal symptoms in Parkinson disease: 18-month follow-up study. Mov Disord 1993; 8 (01) 83-86
  • 18 Edwards LL, Quigley EMM, Harned RK, Hofman R, Pfeiffer RF. Characterization of swallowing and defecation in Parkinson's disease. Am J Gastroenterol 1994; 89 (01) 15-25
  • 19 Chen H, Zhao EJ, Zhang W. et al. Meta-analyses on prevalence of selected Parkinson's nonmotor symptoms before and after diagnosis. Transl Neurodegener 2015; 4 (01) 1
  • 20 Choung RS, Rey E, Richard Locke III G. et al. Chronic constipation and co-morbidities: a prospective population-based nested case-control study. United European Gastroenterol J 2016; 4 (01) 142-151
  • 21 Blekken LE, Nakrem S, Vinsnes AG. et al. Constipation and laxative use among nursing home patients: prevalence and associations derived from the Residents Assessment Instrument for Long-Term Care Facilities (interRAI LTCF). Gastroenterol Res Pract 2016; 2016: 1215746
  • 22 Gage H, Kaye J, Kimber A. et al. Correlates of constipation in people with Parkinson's. Parkinsonism Relat Disord 2011; 17 (02) 106-111
  • 23 Pagano G, Tan EE, Haider JM, Bautista A, Tagliati M. Constipation is reduced by beta-blockers and increased by dopaminergic medications in Parkinson's disease. Parkinsonism Relat Disord 2015; 21 (02) 120-125
  • 24 Ramjit AL, Sedig L, Leibner J. et al. The relationship between anosmia, constipation, and orthostasis and Parkinson's disease duration: results of a pilot study. Int J Neurosci 2010; 120 (01) 67-70
  • 25 Frazzitta G, Ferrazzoli D, Folini A, Palamara G, Maestri R. Severe constipation in Parkinson's disease and Parkinsonism: prevalence and affecting factors. Front Neurol 2019; 10: 621
  • 26 Kenna JE, Bakeberg MC, Abonnel MY, Mastaglia FL, Anderton RS. Impact of gastrointestinal symptoms on health-related quality of life in an Australian Parkinson's disease cohort. Parkinsons Dis 2022; 2022: 4053665
  • 27 Kuusimäki T, Sainio J, Kurki S, Vahlberg T, Kaasinen V. Prediagnostic expressions in health records predict mortality in Parkinson's disease: a proof-of-concept study. Parkinsonism Relat Disord 2022; 95: 35-39
  • 28 Kang SH, Lee J, Koh SB. Constipation is associated with mild cognitive impairment in patients with de novo Parkinson's disease. J Mov Disord 2022; 15 (01) 38-42
  • 29 Santos García D, García Roca L, de Deus Fonticoba T. et al; COPPADIS Study Group. Constipation predicts cognitive decline in Parkinson's disease: result from the COPPADIS cohort at 2-year follow-up and comparison with a control group. J Parkinsons Dis 2022; 12 (01) 315-331
  • 30 Sakakibara R, Ogata T, Aiba Y, Tateno F, Uchiyama T, Yamamoto T. Does depression contribute to the bladder and bowel complaint in Parkinson's disease patients?. Mov Disord Clin Pract (Hoboken) 2020; 8 (02) 240-244
  • 31 Xiao-Ling Q, Gang C, Bo L. et al. Depression is associated with constipation in patients with Parkinson's disease. Front Neurol 2020; 11: 567574
  • 32 Blackley S, Maguire C, Daniels T. Seven cases of sigmoid volvulus in Parkinson's disease. J R Coll Physicians Edinb 2016; 46 (03) 157-159
  • 33 Tateno F, Sakakibara R, Aiba Y. et al. Stercoral ulcer and colonic perforation in an individual with Parkinson's disease with constipation. J Am Geriatr Soc 2016; 64 (10) e118-e120
  • 34 Sung HY, Park JW, Kim JS. The frequency and severity of gastrointestinal symptoms in patients with early Parkinson's disease. J Mov Disord 2014; 7 (01) 7-12
  • 35 Sakakibara R, Shinotoh H, Uchiyama T. et al. Questionnaire-based assessment of pelvic organ dysfunction in Parkinson's disease. Auton Neurosci 2001; 92 (1–2): 76-85
  • 36 Ueki A, Otsuka M. Life style risks of Parkinson's disease: association between decreased water intake and constipation. J Neurol 2004; 251 (Suppl. 07) vII18-vII23
  • 37 Abbott RD, Petrovitch H, White LR. et al. Frequency of bowel movements and the future risk of Parkinson's disease. Neurology 2001; 57 (03) 456-462
  • 38 Yao L, Liang W, Chen J, Wang Q, Huang X. Constipation in Parkinson's disease: a systematic review and meta-analysis. Eur Neurol 2023; 86 (01) 34-44
  • 39 Adams-Carr KL, Bestwick JP, Shribman S, Lees A, Schrag A, Noyce AJ. Constipation preceding Parkinson's disease: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2016; 87 (07) 710-716
  • 40 Camerucci E, Mullan AF, Bower JH. et al. Lifelong constipation in Parkinson's disease and other clinically defined alpha-synucleinopathies: a population-based study in Southeast Minnesota. Parkinsonism Relat Disord 2023; 107: 105244
  • 41 Braak H, Rüb U, Gai WP, Del Tredici K. Idiopathic Parkinson's disease: possible routes by which vulnerable neuronal types may be subject to neuroinvasion by an unknown pathogen. J Neural Transm (Vienna) 2003; 110 (05) 517-536
  • 42 Braak H, de Vos RAI, Bohl J, Del Tredici K. Gastric alpha-synuclein immunoreactive inclusions in Meissner's and Auerbach's plexuses in cases staged for Parkinson's disease-related brain pathology. Neurosci Lett 2006; 396 (01) 67-72
  • 43 Dobbs RJ, Dobbs SM, Weller C. et al. Role of chronic infection and inflammation in the gastrointestinal tract in the etiology and pathogenesis of idiopathic parkinsonism. Part 1: eradication of Helicobacter in the cachexia of idiopathic parkinsonism [corrected in Helicobacter 2005;10(5):557]. Helicobacter 2005; 10 (04) 267-275
  • 44 Bjarnason IT, Charlett A, Dobbs RJ. et al. Role of chronic infection and inflammation in the gastrointestinal tract in the etiology and pathogenesis of idiopathic parkinsonism. Part 2: response of facets of clinical idiopathic parkinsonism to Helicobacter pylori eradication. A randomized, double-blind, placebo-controlled efficacy study [corrected in Helicobacter 2005;10(5):557]. Helicobacter 2005; 10 (04) 276-287
  • 45 Weller C, Charlett A, Oxlade NL. et al. Role of chronic infection and inflammation in the gastrointestinal tract in the etiology and pathogenesis of idiopathic parkinsonism. Part 3: predicted probability and gradients of severity of idiopathic parkinsonism based on H. pylori antibody profile. Helicobacter 2005; 10 (04) 288-297
  • 46 Weller C, Oxlade N, Dobbs SM, Dobbs RJ, Charlett A, Bjarnason IT. Role of inflammation in gastrointestinal tract in aetiology and pathogenesis of idiopathic parkinsonism. FEMS Immunol Med Microbiol 2005; 44 (02) 129-135
  • 47 Pierantozzi M, Pietroiusti A, Brusa L. et al. Helicobacter pylori eradication and l-dopa absorption in patients with PD and motor fluctuations. Neurology 2006; 66 (12) 1824-1829
  • 48 De Pablo-Fernández E, Passananti V, Zárate-López N, Emmanuel A, Warner T. Colonic transit, high-resolution anorectal manometry and MRI defecography study of constipation in Parkinson's disease. Parkinsonism Relat Disord 2019; 66: 195-201
  • 49 Zhang M, Yang S, Li XC. et al. Study on the characteristics of intestinal motility of constipation in patients with Parkinson's disease. World J Gastroenterol 2021; 27 (11) 1055-1063
  • 50 Sakakibara R, Odaka T, Uchiyama T. et al. Colonic transit time and rectoanal videomanometry in Parkinson's disease. J Neurol Neurosurg Psychiatry 2003; 74 (02) 268-272
  • 51 Bassotti G, Maggio D, Battaglia E. et al. Manometric investigation of anorectal function in early and late stage Parkinson's disease. J Neurol Neurosurg Psychiatry 2000; 68 (06) 768-770
  • 52 Ashraf W, Pfeiffer RF, Quigley EMM. Anorectal manometry in the assessment of anorectal function in Parkinson's disease: a comparison with chronic idiopathic constipation. Mov Disord 1994; 9 (06) 655-663
  • 53 Deb B, Sharma M, Fletcher JG. et al. Inadequate rectal pressure and insufficient relaxation and abdominopelvic coordination in defecatory disorders. Gastroenterology 2022; 162 (04) 1111-1122.e2
  • 54 Yu X, Jiang HY, Zhang CX. et al. The role of the diaphragm in postural stability and visceral function in Parkinson's disease. Front Aging Neurosci 2021; 13: 785020
  • 55 Ashraf W, Wszolek ZK, Pfeiffer RF. et al. Anorectal function in fluctuating (on-off) Parkinson's disease: evaluation by combined anorectal manometry and electromyography. Mov Disord 1995; 10 (05) 650-657
  • 56 Mathers SE, Kempster PA, Swash M, Lees AJ. Constipation and paradoxical puborectalis contraction in anismus and Parkinson's disease: a dystonic phenomenon?. J Neurol Neurosurg Psychiatry 1988; 51 (12) 1503-1507
  • 57 Mathers SE, Kempster PA, Law PJ. et al. Anal sphincter dysfunction in Parkinson's disease. Arch Neurol 1989; 46 (10) 1061-1064
  • 58 Gupta A, LaFaver K, Duque KR. et al. Pelvic floor health in women with Parkinson's disease. J Parkinsons Dis 2021; 11 (02) 857-864
  • 59 Blackett JW, Gautam M, Mishra R. et al. Comparison of anorectal manometry, rectal balloon expulsion test, and defecography for diagnosing defecatory disorders. Gastroenterology 2022; 163 (06) 1582-1592.e2
  • 60 Wakabayashi K, Takahashi H, Ohama E. et al. Lewy bodies in the visceral autonomic nervous system in Parkinson's disease. In: Narabayashi H, Yanagisawa N, Mizuno Y. eds. Parkinson's Disease. From Basic Research to Treatment (Advances in Neurology, Vol 60). New York, NY: Raven Press; 1993: 609-612
  • 61 Kupsky WJ, Grimes MM, Sweeting J, Bertsch R, Cote LJ. Parkinson's disease and megacolon: concentric hyaline inclusions (Lewy bodies) in enteric ganglion cells. Neurology 1987; 37 (07) 1253-1255
  • 62 Wakabayashi K, Takahashi H, Ohama E, Ikuta F. Parkinson's disease: an immunohistochemical study of Lewy body-containing neurons in the enteric nervous system. Acta Neuropathol 1990; 79 (06) 581-583
  • 63 Singaram C, Ashraf W, Gaumnitz EA. et al. Dopaminergic defect of enteric nervous system in Parkinson's disease patients with chronic constipation. Lancet 1995; 346 (8979) 861-864
  • 64 Annerino DM, Arshad S, Taylor GM, Adler CH, Beach TG, Greene JG. Parkinson's disease is not associated with gastrointestinal myenteric ganglion neuron loss. Acta Neuropathol 2012; 124 (05) 665-680
  • 65 Beck G, Hori Y, Hayashi Y, Morii E, Takehara T, Mochizuki H. Detection of phosphorylated alpha-synuclein in the muscularis propria of the gastrointestinal tract is a sensitive predictor for Parkinson's disease. Parkinsons Dis 2020; 2020: 4687530
  • 66 Lee HJ, Jung KW, Chung SJ. et al. Relation of enteric α-synuclein to gastrointestinal dysfunction in patients with Parkinson's disease and in neurologically intact subjects. J Neurogastroenterol Motil 2018; 24 (03) 469-478
  • 67 Ohlsson B, Englund E. Atrophic myenteric and submucosal neurons are observed in Parkinson's disease. Parkinsons Dis 2019; 2019: 7935820
  • 68 O'Day C, Finkelstein DI, Diwakarla S, McQuade RM. Critical analysis of intestinal enteric neuron loss and constipation in Parkinson's disease. J Parkinsons Dis 2022; 12 (06) 1841-1861
  • 69 Zheng JH, Sun WH, Ma JJ. et al. Resting-state functional magnetic resonance imaging in patients with Parkinson's disease with and without constipation: a prospective study. Clin Auton Res 2022; 32 (01) 51-58
  • 70 Astarloa R, Mena MA, Sánchez V, de la Vega L, de Yébenes JG. Clinical and pharmacokinetic effects of a diet rich in insoluble fiber on Parkinson disease. Clin Neuropharmacol 1992; 15 (05) 375-380
  • 71 Ashraf W, Pfeiffer RF, Park F, Lof J, Quigley EM. Constipation in Parkinson's disease: objective assessment and response to psyllium. Mov Disord 1997; 12 (06) 946-951
  • 72 Chang L, Sultan S, Lembo A, Verne GN, Smalley W, Heidelbaugh JJ. AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with constipation. Gastroenterology 2022; 163 (01) 118-136
  • 73 Coggrave M, Norton C. Management of faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database Syst Rev 2013; (12) CD002115
  • 74 Rusch C, Beke M, Tucciarone L. et al. Mediterranean diet adherence in people with Parkinson's disease reduces constipation symptoms and changes the fecal microbiota after a 5-week single-arm pilot study. Front Neurol 2021; 12: 794640
  • 75 Xie L, Chen D, Zhu X, Cheng C. Efficacy and safety of probiotics in Parkinson's constipation: a systematic review and meta-analysis. Front Pharmacol 2023; 13: 1007654
  • 76 Edwards LL, Quigley EMM, Harned RK, Hofman R, Pfeiffer RF. Defecatory function in Parkinson's disease: response to apomorphine. Ann Neurol 1993; 33 (05) 490-493
  • 77 Tateno F, Sakakibara R, Yokoi Y. et al. Levodopa ameliorated anorectal constipation in de novo Parkinson's disease: the QL-GAT study. Parkinsonism Relat Disord 2011; 17 (09) 662-666
  • 78 Kamm MA, Mueller-Lissner S, Wald A, Richter E, Swallow R, Gessner U. Oral bisacodyl is effective and well-tolerated in patients with chronic constipation. Clin Gastroenterol Hepatol 2011; 9 (07) 577-583
  • 79 Di Palma JA, Cleveland MV, McGowan J, Herrera JL. A randomized, multicenter comparison of polyethylene glycol laxative and tegaserod in treatment of patients with chronic constipation. Am J Gastroenterol 2007; 102 (09) 1964-1971
  • 80 Sanders JF. Lactulose syrup assessed in a double-blind study of elderly constipated patients. J Am Geriatr Soc 1978; 26 (05) 236-239
  • 81 Bass P, Dennis S. The laxative effects of lactulose in normal and constipated subjects. J Clin Gastroenterol 1981; 3 (Suppl. 01) 23-28
  • 82 Corazziari E, Badiali D, Habib FI. et al. Small volume isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in treatment of chronic nonorganic constipation. Dig Dis Sci 1996; 41 (08) 1636-1642
  • 83 Attar A, Lémann M, Ferguson A. et al. Comparison of a low dose polyethylene glycol electrolyte solution with lactulose for treatment of chronic constipation. Gut 1999; 44 (02) 226-230
  • 84 Corazziari E, Badiali D, Bazzocchi G. et al. Long term efficacy, safety, and tolerabilitity of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut 2000; 46 (04) 522-526
  • 85 DiPalma JA, DeRidder PH, Orlando RC, Kolts BE, Cleveland MB. A randomized, placebo-controlled, multicenter study of the safety and efficacy of a new polyethylene glycol laxative. Am J Gastroenterol 2000; 95 (02) 446-450
  • 86 Zangaglia R, Martignoni E, Glorioso M. et al. Macrogol for the treatment of constipation in Parkinson's disease. A randomized placebo-controlled study. Mov Disord 2007; 22 (09) 1239-1244
  • 87 Lewitan A, Nathanson L, Slade Jr WR. Megacolon and dilatation of the small bowel in parkinsonism. Gastroenterology 1951; 17 (03) 367-374
  • 88 Rosenthal MJ, Marshall CE. Sigmoid volvulus in association with parkinsonism. Report of four cases. J Am Geriatr Soc 1987; 35 (07) 683-684
  • 89 Caplan LH, Jacobson HG, Rubinstein BM, Rotman MZ. Megacolon and volvulus in Parkinson's disease. Radiology 1965; 85: 73-79
  • 90 Bak MP, Boley SJ. Sigmoid volvulus in elderly patients. Am J Surg 1986; 151 (01) 71-75
  • 91 Jost WH, Schimrigk K. Cisapride treatment of constipation in Parkinson's disease. Mov Disord 1993; 8 (03) 339-343
  • 92 Jost WH, Schimrigk K. Long-term results with cisapride in Parkinson's disease. Mov Disord 1997; 12 (03) 423-425
  • 93 Quigley EMM. Cisapride: what can we learn from the rise and fall of a prokinetic?. J Dig Dis 2011; 12 (03) 147-156
  • 94 Liu Z, Sakakibara R, Odaka T. et al. Mosapride citrate, a novel 5-HT4 agonist and partial 5-HT3 antagonist, ameliorates constipation in parkinsonian patients. Mov Disord 2005; 20 (06) 680-686
  • 95 Camilleri M, Kerstens R, Rykx A, Vandeplassche L. A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med 2008; 358 (22) 2344-2354
  • 96 Tack J, van Outryve M, Beyens G, Kerstens R, Vandeplassche L. Prucalopride (Resolor) in the treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut 2009; 58 (03) 357-365
  • 97 Quigley EM, Vandeplassche L, Kerstens R, Ausma J. Clinical trial: the efficacy, impact on quality of life, and safety and tolerability of prucalopride in severe chronic constipation–a 12-week, randomized, double-blind, placebo-controlled study. Aliment Pharmacol Ther 2009; 29 (03) 315-328
  • 98 Johanson JF, Morton D, Geenen J, Ueno R. Multicenter, 4-week, double-blind, randomized, placebo-controlled trial of lubiprostone, a locally-acting type-2 chloride channel activator, in patients with chronic constipation. Am J Gastroenterol 2008; 103 (01) 170-177
  • 99 Barish CF, Drossman D, Johanson JF, Ueno R. Efficacy and safety of lubiprostone in patients with chronic constipation. Dig Dis Sci 2010; 55 (04) 1090-1097
  • 100 Lembo AJ, Johanson JF, Parkman HP, Rao SS, Miner Jr PB, Ueno R. Long-term safety and effectiveness of lubiprostone, a chloride channel (ClC-2) activator, in patients with chronic idiopathic constipation. Dig Dis Sci 2011; 56 (09) 2639-2645
  • 101 Ondo WG, Kenney C, Sullivan K. et al. Placebo-controlled trial of lubiprostone for constipation associated with Parkinson disease. Neurology 2012; 78 (21) 1650-1654
  • 102 Brierley SM. Guanylate cyclase-C receptor activation: unexpected biology. Curr Opin Pharmacol 2012; 12 (06) 632-640
  • 103 Andresen V, Camilleri M, Busciglio IA. et al. Effect of 5 days linaclotide on transit and bowel function in females with constipation-predominant irritable bowel syndrome. Gastroenterology 2007; 133 (03) 761-768
  • 104 Lembo AJ, Schneier HA, Shiff SJ. et al. Two randomized trials of linaclotide for chronic constipation. N Engl J Med 2011; 365 (06) 527-536
  • 105 Freitas ME, Alqaraawi A, Lang AE, Liu LWC. Linaclotide and prucalopride for management of constipation in patients with Parkinsonism. Mov Disord Clin Pract (Hoboken) 2018; 5 (02) 218-220
  • 106 Cadeddu F, Bentivoglio AR, Brandara F, Marniga G, Brisinda G, Maria G. Outlet type constipation in Parkinson's disease: results of botulinum toxin treatment. Aliment Pharmacol Ther 2005; 22 (10) 997-1003
  • 107 Albanese A, Brisinda G, Bentivoglio AR, Maria G. Treatment of outlet obstruction constipation in Parkinson's disease with botulinum neurotoxin A. Am J Gastroenterol 2003; 98 (06) 1439-1440
  • 108 Triadafilopoulos G, Gandhy R, Barlow C. Pilot cohort study of endoscopic botulinum neurotoxin injection in Parkinson's disease. Parkinsonism Relat Disord 2017; 44: 33-37
  • 109 McClurg D, Hagen S, Jamieson K, Dickinson L, Paul L, Cunnington A. Abdominal massage for the alleviation of symptoms of constipation in people with Parkinson's: a randomised controlled pilot study. Age Ageing 2016; 45 (02) 299-303
  • 110 McClurg D, Walker K, Aitchison P. et al. Abdominal massage for the relief of constipation in people with Parkinson's: a qualitative study. Parkinsons Dis 2016; 2016: 4842090
  • 111 Chiu CM, Wang CP, Sung WH, Huang SF, Chiang SC, Tsai PY. Functional magnetic stimulation in constipation associated with Parkinson's disease. J Rehabil Med 2009; 41 (13) 1085-1089
  • 112 Li K, Xu S, Wang R. et al. Electroacupuncture for motor dysfunction and constipation in patients with Parkinson's disease: a randomised controlled multi-centre trial. EClinicalMedicine 2023; 56: 101814
  • 113 Song LZ, Li Y, Qian X. et al. Parkinson's disease constipation effect of electroacupuncture at ST25 through colonic motility and enteric neuropathology. Front Neurol 2023; 13: 1092127
  • 114 Li YJ, Leong II, Fan JQ. et al. Efficacy of acupuncture for the treatment of Parkinson's disease-related constipation (PDC): a randomized controlled trial. Front Neurosci 2023; 17: 1126080
  • 115 Nishiwaki H, Ito M, Ishida T. et al. Meta-analysis of gut dysbiosis in Parkinson's disease. Mov Disord 2020; 35 (09) 1626-1635
  • 116 Fu SC, Shih LC, Wu PH. et al. Exploring the causal effect of constipation on Parkinson's disease through mediation analysis of microbal data. Front Cell Infect Microbiol 2022; 12: 871710
  • 117 Chen W, Bi Z, Zhu Q. et al. An analysis of the characteristics of the intestinal flora in patients with Parkinson's disease complicated with constipation. Am J Transl Res 2021; 13 (12) 13710-13722
  • 118 Kuai XY, Yao XH, Xu LJ. et al. Evaluation of fecal microbiota transplantation in Parkinson's disease patients with constipation. Microb Cell Fact 2021; 20 (01) 98
  • 119 Huang H, Xu H, Luo Q. et al. Fecal microbiota transplantation to treat Parkinson's disease with constipation: a case report. Medicine (Baltimore) 2019; 98 (26) e16163
  • 120 Van Laar T, Boertien JM, Herranz AH. Faecal transplantation, pro- and prebiotics in Parkinson's disease; hope or hype?. J Parkinsons Dis 2019; 9 (s2, suppl 2): S371-S379
  • 121 Camilleri M, Subramanian T, Pagan F. et al. Oral ENT-01 targets enteric neurons to treat constipation in Parkinson's disease. Ann Intern Med 2022; 175: 1666-1674