Nausea, Vomiting, and Reflux

FSSG was created in Japan for physicians, including general practitioners, to not only assist in the initial diagnosis of GERD, but also allow quantitative assessment of the effects of treatment and the changes in symptoms over time [8]. A significant reduction in the FSSG score occurs in patients with both mild and severe GERD after therapy with PPI [9]. FSSG contains the 12 symptoms most commonly experienced by GERD patients, with 7 being reflux symptoms and the remaining 5 being dyspeptic symptoms. When the total score is more than 8, GERD can be diagnosed with 62% sensitivity and 59% specificity.

This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.

This study suggests that GERD is prevalent in PD. Deterioration of daily living activities and other nonmotor symptoms can imply the presence of GERD. Because clinical symptoms of GERD are usually treatable, the management can improve the patient’s quality of life.

Marie Elisabeth Riechmann (born Sp̦nemann), 1745 Р1807 Marie Elisabeth Riechmann (born Sp̦nemann)

Dysphagia is relatively common and observed in 29%-80% of PD patients [2, 3], which can be induced by dyscoordination of various organs such as the mouth, pharynx, and esophagus. In addition to abnormalities of esophageal peristalsis, dysfunction in the lower esophageal sphincter can also produce clinical symptoms of gastroesophageal reflux [4-6]. Treatment of esophageal problems in PD still remains difficult. However, symptoms derived from gastroesophageal reflux can be treated with appropriate antireflux measures.

Nonmotor symptoms are troublesome for PD patients and physicians because conventional dopaminergic therapy does not always work efficiently in the management of these symptoms. Therefore, physicians should be alert for treatable symptoms. The diagnosis of GERD is commonly based on the history or findings from upper gastrointestinal endoscopy. As a therapeutic diagnostic method, 24 h esophageal pH monitoring combined with the PPI test [33] is also used. Because clinical history-based diagnosis is the simplest and quickest, demanding no additional workload of the patients, it is suitable for clinical practice.

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.

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.

Our patient-control study suggested that GERD, as defined by the FSSG score, was more prevalent in PD patients than in the healthy controls. The prevalence rate was 26.5%. The presence of PD increased the prevalence rate of GERD to 4.1 times higher than that of the age-matched controls. These findings indicated that PD can be a risk factor of GERD.

Although PD is still the most well-known movement disorder, growing recognition of variable nonmotor symptoms suggests that PD is a systemic disease. Nonmotor symptoms of PD are a major cause of disability for PD patients, and recognition and treatment of nonmotor symptoms are important to maintain comprehensive healthcare for PD patients [3, 10, 11].

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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].

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