Utility of the wireless motility capsule and lactulose breath testing in the evaluation of patients with Parkinson's disease who present with functional gastrointestinal symptoms

Andrew Su; Rita Gandhy; Carrolee Barlow; George Triadafilopoulos

doi:10.1136/bmjgast-2017-000132

Utility of the wireless motility capsule and lactulose breath testing in the evaluation of patients with Parkinson's disease who present with functional gastrointestinal symptoms

BMJ Open Gastroenterol. 2017 Feb 23;4(1):e000132. doi: 10.1136/bmjgast-2017-000132. eCollection 2017.

Authors

Andrew Su¹, Rita Gandhy², Carrolee Barlow², George Triadafilopoulos³

Affiliations

¹ Department of Medicine , Stanford University School of Medicine , Stanford, California , USA.
² The Parkinson's Institute , Sunnyvale, California , USA.
³ Department of Medicine, Stanford University School of Medicine, Stanford, California, USA; Department of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.

Abstract

Background: The aetiology and origin of gastrointestinal symptoms in Parkinson's disease (PD) remains poorly understood. Gastroparesis, small bowel transit delay and bacterial overgrowth may, individually or collectively, play a role.

Aims: In patients with PD and functional gastrointestinal symptoms, we aimed to determine the utility of the wireless motility capsule and lactulose breath tests in further defining their symptoms' aetiology.

Methods: In this retrospective cohort study, consecutive patients with PD and functional gastrointestinal symptoms underwent clinical assessment, as well as wireless motility capsule and lactulose breath testing using standard protocols.

Results: We studied 65 patients with PD and various gastrointestinal symptoms. 35% exhibited gastroparesis by the wireless motility capsule study, 20% small bowel transit delay, while 8% had combined transit abnormalities, suggestive of overlapping gastric and small bowel dysmotility. Small bowel bacterial overgrowth was seen in 34% of cases. Symptoms of abdominal pain, regurgitation, bloating, nausea, vomiting, belching and weight loss could not distinguish between patients with or without gastroparesis, although bloating was significantly more prominent (p<0.001) overall and specifically more so in patients with slow small bowel transit (p<0.01). There was no relationship between delayed small bowel transit time and bacterial overgrowth (p=0.5); PD scores and duration were not correlated with either the transit findings or small bowel bacterial overgrowth.

Conclusions: Functional gastrointestinal symptoms in patients with PD may reflect gastroparesis, small bowel transit delay or both, suggesting motor and/or autonomic dysfunction, and may be associated with small bowel bacterial overgrowth. The wireless motility capsule and lactulose breath testing are non-invasive and useful in the assessment of these patients.

Keywords: BACTERIAL OVERGROWTH; FUNCTIONAL BOWEL DISORDER; GASTROINTESTINAL MOTILITY; GASTROPARESIS.