Although Lewy bodies in the alimentary system have been reported in autopsy cases with megacolon and achalasia [13-15], there is no direct evidence of the association between GERD and the lower esophageal Lewy bodies. However, these previous reports reasonably support that pathological abnormality of the lower esophagus may cause the clinical symptoms of GERD in PD.
The lower esophagus is one of the extra central nervous organs that share Lewy bodies, which are frequently found in Auerbach’s plexus. Pathological abnormalities may induce variable degrees of functional disorders in the lower esophagus.
pylori can improve these annoying problems in H. pylori-infected PD patients. However, it is unpredictable whether H. pylori eradication is helpful for improving symptoms of GERD in PD patients because the effect of eradication is still controversial in patients with GERD [30-32].
Anna. Maria Dorothea. Scheve (born Riechmann), 1794 – 1858
The results of the analysis comparing between PD with and without GERD suggested that GERD was clinically characterized by subjective heartburn and was more common in the advanced stage presenting with the wearing-off phenomenon. The analysis also suggested that GERD could cause deterioration of patients’ daily living activities and quality of life and that GERD was associated with the presence of other nonmotor symptoms. Furthermore, daily living activity and nonmotor symptoms can be independent relating factors of GERD in PD. These results suggest that GERD is a frequent nonmotor problem and a deteriorating factor of daily living activity in PD patients.
- We cannot exclude the possibility that our results were peculiar to the outpatient.
- Like NVP, the normal physiologic changes of pregnancy contribute to its development and often make management difficult.
- These results suggest that GERD is a frequent nonmotor problem and a deteriorating factor of daily living activity in PD patients.
- Autonomic dysfunction is an important clinical component of extrapyramidal disease, but it is often not formally assessed, and thus frequently misdiagnosed.
- Therefore, physicians should be alert for treatable symptoms.
Variable symptoms in the alimentary system from the mouth to the anorectum have been reported . Gastrointestinal problems are also a type of nonmotor symptoms. All parts of the gastrointestinal tract can be affected, even in the earlier phase of the disease course in some cases.
Gastroesophageal reflux symptoms characterized by heartburn and regurgitation are generally recognized as clinical symptoms of gastroesophageal reflex disease (GERD). GERD can also show dyspeptic manifestations other than reflux symptoms.
In PD patients, disease duration and severity, quality of life, and nonmotor symptoms were also examined and then the clinical features of GERD were analyzed. A total of 102 patients and 49 controls were enrolled and 21 patients and 4 controls had heartburn, significantly frequent in PD. The prevalence rate of GERD was 26.5% in PD and the odds ratio was 4.05. Heartburn, bent forward flexion, and wearing-off phenomenon were frequent, and scores of UPDRS, total and part II, PD questionnaire-39, and nonmotor symptom scale were significantly higher in PD patients with GERD than without GERD. Multiple logistic regression analysis revealed statistical significance in UPDRS part II and nonmotor symptom scale.
Symptoms of autonomic dysfunction can impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient.
This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.