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Probiotics for Constipation in Parkinson Disease
TAKE-HOME MESSAGE
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Constipation is prevalent in patients with Parkinson disease (PD), can be an important source of morbidity, and can lead to severe complications. Management remains challenging. The authors of this double-blind, placebo-controlled, randomized controlled trial tested the efficacy of multistrain probiotic capsules as a treatment for constipation in PD. The average number of weekly spontaneous bowel movements increased by 1.0 from the 2-week pre-intervention phase to the last 2 weeks of the intervention phase in the treatment group (baseline, 2.6), and decreased by 0.3 in the placebo group (baseline, 2.8). Secondary outcomes, including quality of life related to constipation, also favored the active treatment. No significant safety concerns emerged.
- This multistrain probiotic treatment was effective and safe in treating constipation in patients with PD.
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To determine whether probiotics are effective for constipation, a common and often difficult-to-treat problem, in Parkinson disease (PD).
METHODS
In this double-blind, randomized, placebo-controlled, single-center trial, 280 patients with PD were screened, and 72 eligible patients were block-randomized (1:1) to receive either multistrain probiotics capsules (n = 34) or identical-appearing placebo (n = 38), for 4 weeks. The primary endpoint was the change in the average number of spontaneous bowel movements (SBM) per week during the last 2 weeks of intervention compared with the 2-week preintervention phase, recorded by daily stool diary. Secondary outcome measures included changes in stool consistency, constipation severity score, and quality of life related to constipation. Satisfaction with intervention received was assessed. Change in levels of fecal calprotectin, a marker of intestinal inflammation, was an exploratory outcome.
RESULTS
SBM increased by 1.0 ± 1.2 per week after treatment with probiotics and decreased by 0.3 ± 1.0 per week in the placebo group (mean difference 1.3, 95% confidence interval 0.8-1.8, p < 0.001). Significant improvements were also seen for secondary outcomes after correction for multiple comparisons, including stool consistency (p = 0.009) and quality of life related to constipation (p = 0.001). In the treatment group, 65.6% reported satisfaction with the intervention vs only 21.6% in the placebo group (p < 0.001). One patient (2.9%) in the treatment group withdrew due to a nonserious adverse event. Fecal calprotectin did not change significantly during the study.
CONCLUSIONS
Multistrain probiotics treatment was effective for constipation in PD. Further studies are needed to investigate the long-term efficacy and safety of probiotics in PD, as well as their mechanisms of action.
CLINICALTRIALSGOV IDENTIFIER
NCT03377322.
CLASSIFICATION OF EVIDENCE
This study provides Class I evidence that, for people with PD, multistrain probiotics significantly increased the average number of SBM per week.
Additional Info
Disclosure statements are available on the authors' profiles:
Probiotics for Constipation in Parkinson Disease: A Randomized Placebo-Controlled Study
Neurology 2021 Feb 02;96(5)e772-e782, AH Tan, SY Lim, KK Chong, MAA A Manap, JW Hor, JL Lim, SC Low, CW Chong, S Mahadeva, AE LangFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Neurology
Constipation is common in the general population but has significant impact on quality of life, and even causes gastrointestinal (GI) emergencies (intestinal pseudo-obstruction, stool-induced ulcer, volvulus), with morbidity particularly affecting Parkinson’s disease (PD) patients. In addition, reduced GI motility is well known to affect levodopa absorption, leading to delayed-on and no-on, particularly in elderly PD patients (brain-to-gut axis). From the pathophysiology perspective, the GI tract is one of places where synucleinopathy disease process begins. In that condition, constipation can be the sole, initial manifestation of PD, and the correct diagnosis of the “Lewy body-type constipation” 1 is important for initiating early disease-modifying therapies. In parallel with this, management of constipation might also modify disease progression (gut-to-brain axis). Nevertheless, constipation in PD is still underestimated.
A recent publication by Tan et al beautifully presented their results, showed in a double-blind, randomized, placebo-controlled manner. The number of spontaneous bowel movements in PD increased by 1.0 ± 1.2 per week after a 4-week treatment with probiotics (n = 34) and decreased by 0.3 ± 1.0 per week with placebo (n = 38) [P < .001]. Changes were also seen in stool consistency (P = .009) and quality of life related to constipation (P = .001) and patient satisfaction. Only 1 patient (2.9%) in the treatment group withdrew due to a non-serious adverse event. Fecal calprotectin (a marker for neutrophil migration) did not change significantly.
Recently, gut microbiota have attracted attention. This is because gut microbiota might affect host immunity, metabolism, and even neural function, including the brain. Probiotics (Lactobacillus, Bifidobacterium, etc) have long been a friend to us and time-tested. The results by Tan et al that probiotics brought about mild but significant improvement in constipation in PD, most probably through modifying gut microbiota, will add a new lifestyle and health benefit for the patients. Studies focusing on gene-based change in microbiota will clarify the mechanism of probiotics further.
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