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

Roongroj Bhidayasiri; Warongporn Phuenpathom; Ai Huey Tan; Valentina Leta; Saisamorn Phumphid; K. Ray Chaudhuri; Pramod Kumar Pal

doi:10.3389/fnagi.2022.979826

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

Roongroj Bhidayasiri^*, Warongporn Phuenpathom, Ai Huey Tan, Valentina Leta, Saisamorn Phumphid, K. Ray Chaudhuri, Pramod Kumar Pal

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

10 Citations (Scopus)

Abstract

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.

Original language	English
Article number	979826
Journal	Frontiers in Aging Neuroscience
Volume	14
DOIs	https://doi.org/10.3389/fnagi.2022.979826
Publication status	Published - 11 Aug 2022

Keywords

diagnosis
dysphagia
gastroparesis
multidisciplinary team
non-pharmacological treatment
Parkinson’s disease
pharmacological treatment
treatment

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10.3389/fnagi.2022.979826

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title = "Management of dysphagia and gastroparesis in Parkinson{\textquoteright}s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches",

abstract = "Gastrointestinal (GI) issues are commonly experienced by patients with Parkinson{\textquoteright}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 {\textquoteleft}real-world{\textquoteright} 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.",

keywords = "diagnosis, dysphagia, gastroparesis, multidisciplinary team, non-pharmacological treatment, Parkinson{\textquoteright}s disease, pharmacological treatment, treatment",

author = "Roongroj Bhidayasiri and Warongporn Phuenpathom and Tan, {Ai Huey} and Valentina Leta and Saisamorn Phumphid and Chaudhuri, {K. Ray} and Pal, {Pramod Kumar}",

note = "Funding Information: RB was supported by Senior Research Scholar Grant (RTA6280016) of the Thailand Science Research and Innovation (TSRI), International Research Network Grant of the Thailand Research Fund (IRN59W0005), and Center of Excellence grant of Chulalongkorn University (GCE 6100930004-1). Publisher Copyright: Copyright {\textcopyright} 2022 Bhidayasiri, Phuenpathom, Tan, Leta, Phumphid, Chaudhuri and Pal.",

year = "2022",

month = aug,

day = "11",

doi = "10.3389/fnagi.2022.979826",

language = "English",

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Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches. / Bhidayasiri, Roongroj; Phuenpathom, Warongporn; Tan, Ai Huey et al.
In: Frontiers in Aging Neuroscience, Vol. 14, 979826, 11.08.2022.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Management of dysphagia and gastroparesis in Parkinson’s disease in real-world clinical practice – Balancing pharmacological and non-pharmacological approaches

AU - Bhidayasiri, Roongroj

AU - Phuenpathom, Warongporn

AU - Tan, Ai Huey

AU - Leta, Valentina

AU - Phumphid, Saisamorn

AU - Chaudhuri, K. Ray

AU - Pal, Pramod Kumar

N1 - Funding Information: RB was supported by Senior Research Scholar Grant (RTA6280016) of the Thailand Science Research and Innovation (TSRI), International Research Network Grant of the Thailand Research Fund (IRN59W0005), and Center of Excellence grant of Chulalongkorn University (GCE 6100930004-1). Publisher Copyright: Copyright © 2022 Bhidayasiri, Phuenpathom, Tan, Leta, Phumphid, Chaudhuri and Pal.

PY - 2022/8/11

Y1 - 2022/8/11

N2 - 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.

AB - 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.

KW - diagnosis

KW - dysphagia

KW - gastroparesis

KW - multidisciplinary team

KW - non-pharmacological treatment

KW - Parkinson’s disease

KW - pharmacological treatment

KW - treatment

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SN - 1663-4365

VL - 14

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M1 - 979826

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

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Keywords

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