Gastrointestinal Dysfunction in Parkinson's Disease
Gastrointestinal Dysfunction in Parkinson's Disease
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DOI：
10.1055/s-2008-1040981
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发表时间：
1996-09
影响因子：
2.7
通讯作者：
E. Quigley
中科院分区：
文献类型：
--
作者：
E. Quigley
胃肠功能障碍在帕金森病患者中很常见，具有重要的临床意义。不断积累的证据表明，这些症状在很大程度上反映了PD过程直接累及胃肠道。胃肠道症状的出现不仅是帕金森病对口咽、肛门直肠和盆底骨骼肌影响的结果，也可能是自主神经和肠道神经系统直接参与帕金森病过程的结果。虽然帕金森病患者胃肠功能障碍的许多方面仍在被描述，但这种常见疾病的肠道症状的治疗方法仍处于起步阶段。肠道参与帕金森病可被视为肠道-中枢神经系统相互作用的范例。最近发现的肠道神经系统的神经病理异常类似于中枢神经系统帕金森病的病因学异常，这表明肠道和中枢神经系统可能在一些以前被认为局限于中枢和躯体神经系统的疾病过程中表现出平行的病理变化。通过这种方式，肠道神经系统很可能成为一扇更容易接触到的各种退行性神经疾病的“窗口”。关于帕金森病本身，我们可以开始将这种疾病的神经学和胃肠道表现与许多水平的缺陷联系起来(表1)。
Gastrointestinal dysfunction is common and clinically important in patients with PD. Evidence continues to accumulate to indicate that these symptoms reflect, for the most part, the direct involvement of the gastrointestinal tract by the PD process. Gastrointestinal symptomatology may arise not only as a consequence of the effects of PD on skeletal muscles in the oropharynx, anorectum, and pelvic floor but also through the direct involvement of the autonomic and enteric nervous systems in the PD process. While many aspects of gastrointestinal dysfunction in PD continue to be delineated, therapeutic approaches to gut symptoms in this common disorder remain in their infancy. Gut involvement in PD can be seen to serve as a paradigm for gut-CNS interactions. The recent demonstration of neuropathologic abnormalities in the enteric nervous system analogous to those regarded as pathognomonic of the parkinsonian process in the CNS suggests that the enteric and central nervous systems may demonstrate parallel pathologic changes in a number of disease processes previously regarded as confined to the central and somatic nervous systems. In this way, the enteric nervous system may well serve as a more accessible "window" to a variety of degenerative neurologic disorders. With respect to PD itself, we can begin to relate both the neurologic and gastrointestinal manifestations of this disorder to defects at a number of levels (Table 1).