Gastrointestinale Störungen bei Morbus Parkinson

Zusammenfassung

Schon James Parkinson beschrieb gastrointestinale Dysfunktionen wie vermehrtes Speichelaufkommen, Schluckstörungen und chronische Obstipation. Parkinsonpatienten berichten auch über typische dyspeptische Beschwerden wie Übelkeit, Völlegefühl, frühes Sättigungsgefühl, epigastrische Beschwerden, Erbrechen, Sodbrennen und Meteorismus. Diese können auch von der gastrointestinalen Motilität mit verursacht werden. Eine reduzierte Magenentleerung wird sogar als ein prämotorisches Symptom des Morbus Parkinson diskutiert, da eine Verlangsamung der Magenentleerung auch bei unbehandelten Parkinsonpatienten gezeigt werden konnte und ebenso im Bereich des die intestinale motorische Funktion steuernden enterischen Nervensystems Lewy-Körperchen gehäuft gefunden wurden. Unklar sind die Effekte, die die Therapie mit Levodopa auf die gastrointestinale Motilität ausübt. Zu diskutieren sind neben einem Serotoninmangel, einerseits durch verminderte Aufnahme von Tryptophan oder Abbau von Levodopa zu Dopamin in gastrointestinalen serotonergen neuronalen Zellen. Dies hat vor dem Hintergrund der 5-HT-Rezeptor-gesteuerten Peristaltik einen hypothetischen Einfluss auf die häufige Manifestation einer chronischen Obstipation bei mit Levodopa behandelten Parkinsonpatienten.

Abstract

Even James Parkinson described gastrointestinal symptoms, such as increased saliva in the mouth, dysphagia and chronic constipation. Patients with Parkinson's disease (PD) also complain about typical dyspeptic symptoms such as nausea, fullness, early satiety epigastric pain, vomiting heartburn and meteorism. These symptoms may also result from reduced gastrointestinal motility. Delayed gastric emptying is even discussed as premotor symptom of PD. This was even shown in untreated PD patients and may result from increased appearance of lewy bodies in the enteric nervous system. The impact of levodopa application on gastrointestinal motility is not well studied, levodopa itself delays gastric emptying. However, long-term levodopa application may hypothetically also impact duodenal, jejunal and caecal motility due to decreased tryptophane uptake, which is the metabolic precursor of 5-HT, or the metabolism of levodopa in 5-HT metabolising gastrointestinal neuronal cells. Both may hypothetically cause decreased gastrointestinal 5-HT levels, which may support onset of chronic constipation, since 5-HT stimulates gastrointestinal motility. Constipation is frequent in levodopa treated PD patients.

Levodopa - Magenentleerung - Obstipation

levodopa - gastric emptying - constipation

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