Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease
Background & aims: Gastrointestinal (GI) symptoms are common in Parkinson’s Disease (PD) patients, and GI dysmotility is thought to induce motor fluctuations, requiring escalation of levodopa therapy. The role of GI consultation in managing such symptoms, however, is unclear. In this study,...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-01-01
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| Series: | Clinical Parkinsonism & Related Disorders |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590112523000336 |
| _version_ | 1797401682374557696 |
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| author | Jocelyn J. Chang Sanjay R.V. Gadi Aleksandar Videnovic Braden Kuo Trisha S. Pasricha |
| author_facet | Jocelyn J. Chang Sanjay R.V. Gadi Aleksandar Videnovic Braden Kuo Trisha S. Pasricha |
| author_sort | Jocelyn J. Chang |
| collection | DOAJ |
| description | Background & aims: Gastrointestinal (GI) symptoms are common in Parkinson’s Disease (PD) patients, and GI dysmotility is thought to induce motor fluctuations, requiring escalation of levodopa therapy. The role of GI consultation in managing such symptoms, however, is unclear. In this study, we investigate the possible association between GI dysmotility symptoms and escalated LEDD therapy, as well as factors associated with GI consultation for PD symptom management. Methods: This was a retrospective case-study of 248 PD patients evaluated by outpatient neurology at Massachusetts General Brigham Healthcare from 2018 to 2022. Logistic regression, t-test, and Fisher exact tests were performed to identify factors associated with GI consult, change in LEDD with consult, and association of consultation with GI diagnoses and treatments, respectively. Results: Among 248 PD patients, 12.9% received GI consultation despite 96.8% having GI symptoms. Bloating was the primary symptom associated with receiving GI consultation (OR 3.59 [95% CI 1.47–8.88], p = 0.005). GI consultation increased the odds of receiving GI-specific medications (78.2% vs 46.3%, p = 0.001) and specialized GI diagnoses like gastroparesis (9.4% vs 0.46%, p < 0.001) and pelvic floor dysfunction (15.6% vs 0%, p < 0.0001). Interestingly, LEDD tended not to change after GI consultation, and dysmotility symptoms, including bloating, did not predict need for higher LEDD. Conclusions: While treating symptoms of dysmotility may not ameliorate levodopa-based motor fluctuations as much as previously thought, GI consultations are underutilized in PD, and patients who receive GI consultation are more likely to have changes in GI diagnosis and treatment. |
| first_indexed | 2024-03-09T02:13:37Z |
| format | Article |
| id | doaj.art-59ab2a27784d4b6c8ff581d04d6482bf |
| institution | Directory Open Access Journal |
| issn | 2590-1125 |
| language | English |
| last_indexed | 2024-03-09T02:13:37Z |
| publishDate | 2023-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Parkinsonism & Related Disorders |
| spelling | doaj.art-59ab2a27784d4b6c8ff581d04d6482bf2023-12-07T05:30:11ZengElsevierClinical Parkinsonism & Related Disorders2590-11252023-01-019100215Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s DiseaseJocelyn J. Chang0Sanjay R.V. Gadi1Aleksandar Videnovic2Braden Kuo3Trisha S. Pasricha4Tufts University School of Medicine, Boston, MA, United States; Corresponding author at: Tufts University School of Medicine, 136 Harrison Avenue Boston, MA 02111, United States.Department of Medicine, Duke University Health System, Durham, NC, United States; Harvard Medical School, Boston, MA, United StatesNeurological Clinical Research Institute, Department of Neurology, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United StatesHarvard Medical School, Boston, MA, United States; Center for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United StatesHarvard Medical School, Boston, MA, United States; Center for Neurointestinal Health, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA, United StatesBackground & aims: Gastrointestinal (GI) symptoms are common in Parkinson’s Disease (PD) patients, and GI dysmotility is thought to induce motor fluctuations, requiring escalation of levodopa therapy. The role of GI consultation in managing such symptoms, however, is unclear. In this study, we investigate the possible association between GI dysmotility symptoms and escalated LEDD therapy, as well as factors associated with GI consultation for PD symptom management. Methods: This was a retrospective case-study of 248 PD patients evaluated by outpatient neurology at Massachusetts General Brigham Healthcare from 2018 to 2022. Logistic regression, t-test, and Fisher exact tests were performed to identify factors associated with GI consult, change in LEDD with consult, and association of consultation with GI diagnoses and treatments, respectively. Results: Among 248 PD patients, 12.9% received GI consultation despite 96.8% having GI symptoms. Bloating was the primary symptom associated with receiving GI consultation (OR 3.59 [95% CI 1.47–8.88], p = 0.005). GI consultation increased the odds of receiving GI-specific medications (78.2% vs 46.3%, p = 0.001) and specialized GI diagnoses like gastroparesis (9.4% vs 0.46%, p < 0.001) and pelvic floor dysfunction (15.6% vs 0%, p < 0.0001). Interestingly, LEDD tended not to change after GI consultation, and dysmotility symptoms, including bloating, did not predict need for higher LEDD. Conclusions: While treating symptoms of dysmotility may not ameliorate levodopa-based motor fluctuations as much as previously thought, GI consultations are underutilized in PD, and patients who receive GI consultation are more likely to have changes in GI diagnosis and treatment.http://www.sciencedirect.com/science/article/pii/S2590112523000336Gastric dysmotilityParkinson’s DiseaseGI consultationMotor fluctuationsLevodopa malabsorption |
| spellingShingle | Jocelyn J. Chang Sanjay R.V. Gadi Aleksandar Videnovic Braden Kuo Trisha S. Pasricha Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease Clinical Parkinsonism & Related Disorders Gastric dysmotility Parkinson’s Disease GI consultation Motor fluctuations Levodopa malabsorption |
| title | Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease |
| title_full | Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease |
| title_fullStr | Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease |
| title_full_unstemmed | Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease |
| title_short | Impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in Parkinson’s Disease |
| title_sort | impact of outpatient gastroenterology consult on pharmacotherapy and management of gastrointestinal symptoms in parkinson s disease |
| topic | Gastric dysmotility Parkinson’s Disease GI consultation Motor fluctuations Levodopa malabsorption |
| url | http://www.sciencedirect.com/science/article/pii/S2590112523000336 |
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