The fixel GI Parkinson's research and integrated support model (PRISM)

BackgroundThe complexity of gastrointestinal (GI) disorders associated with Parkinson's disease (PD) and the significant interactions between GI medications and the dopaminergic axis necessitates expert management. The integrated care model for disorders of the brain-gut interaction (DBGI) has advantages, however, has not been applied in concurrent DBGI and PD.ObjectiveTo test the hypothesis that our Parkinson's Research and Integrated Support Model (PRISM) will reduce symptom severity and improve the quality of life (QOL) in patients with GI symptoms associated with PD.MethodsPatients with refractory GI symptoms referred to the PRISM clinic were evaluated and treated by the integrated efforts of movement disorder specialists, neurogastroenterologists, dietitians, occupational therapists, speech-swallow therapists, and neuroscientists. Patients underwent a battery of GI symptoms and QOL questionnaires and personalized actionable biomarkers (motility testing and swallowing studies). Inflammatory markers and stool tests were collected. An individualized standard of care treatment was established based on the specific DBGI diagnosis uncovered during the PRISM evaluation.Results44 adult PD patients with GI complaints were evaluated. The most common symptoms included constipation (97%), dysphagia (61%), and gastroesophageal reflux (34%). Actionable biomarkers were highly positive revealing esophageal dysmotility (20/21, 95%), slow-transit constipation (40/42, 90%), intestinal methanogen overgrowth (7/8, 87%), gastroparesis (17/20, 85%), oropharyngeal dysphagia (28/44, 63%), and dyssynergic defecation (27/42, 61%). GI symptom severity and QOL significantly improved (p < 0.05) as measured by all questionnaires.ConclusionsMore severely affected patients with Parkinson's treated with the Fixel PRISM approach showed significant improvements in GI symptom frequency, severity, and QOL.