“People who later develop Parkinson’s disease often have GI symptoms such as constipation and nausea even as far back as 10 years or more before the development of developing any motor symptoms like difficulty walking or having tremors,” according to the author’s statement, Trisha S. Pasricha.
The assumption that Parkinson’s disease is a brain disease has been inflicting clinicians for the past decades. But this research has provided further support to the idea that it should perhaps be thought of, as originating from the gut.
According to research, it has been revealed that individuals with upper gastrointestinal diseases such as Peptic ulcers and damage to the oesophageal are likely to have Parkinson’s disease in their later years of life. “There is an increasing literature that, at least in a fraction of the population. Parkinson’s disease starts from the gut, and then advances to the CNS,” said Trisha S. Pasricha, who is a neurogastroenterologist as well as the Director of Clinical Research at the Institute for Gut-Brain Research, Beth Israel Deaconess Medical Center(BIDMC).
She also remarked to The Harvard Gazette,” In the case of patients diagnosed with Parkinson’s disease, GI complaints such as constipation and nausea can occur to them for quite a few years if not decades, before the progression into neurological symptoms such as walking difficulties and tremors. In our lab, we have tried to emphasize this innate ‘ gut-first’ pathway of Parkinson’s because it brings about new approaches to the problem in terms of early diagnostics and especially treatment.”
This will potentially change the way we think of the illness and its detection and management in its earliest stages. It may be that the relationship between the gut and brain will enhance the possible methods of alleviating symptoms and limiting the degree of developing disease. Consultant gastroenterologist at Fortis Hospital Bengaluru Dr. Pranav Honnavara Srinivasan has his views on this key development.
Parkinson’s disease: The ‘gut-first’ hypothesis gains traction.
In weighing the opinion of the Harvard study, it can be concluded that many researchers favor the ‘gut-first’ hypothesis for Parkinson’s disease. Dr. Srinivasan explains, “So, research showed that misfolded alpha-synuclein proteins. Which are responsible for the progression of Parkinson’s disease, can start from the gut and then be transported to the brain through the vagus nerve. Hence, the disease could start in the GI tract where it remains quiescent before invading the brain.”
This hypothesis goes against the classic view which states that the origin of Parkinson’s disease is in the brain and then spreads to other sites such as, for instance, the dot. The ‘gut-first’ theory is becoming more accepted since a lot of patients with the disease report gut problems such as slow movement of the bowel even before such symptoms as handshaking develop.
Gastrointestinal conditions as early warning signs
Srinivasan points towards the gastrointestinal symptoms, noting these to be significant during the diagnosis of the disease-affected communication. “She adds, chronic constipation ulcers and damage to the esophagus have now also emerged as signs of the disease in progression. The Harvard study mentions that these may be related to the peripheral nervous system where these abnormal proteins could gather before being spread to the central nervous system itself.”
He further stated that patients with persistent gastrointestinal disorders might be more prone to develop Parkinson’s disease. “Studies indicate that some symptoms such as constipation may occur many years before motor dysfunction and this may provide a useful window of opportunity in terms of diagnosis. Swallowing difficulties or acid indigestion. Which are conditions related to the esophagus, could help in understanding how the gut-brain axes shifted and might be early signs of the disease.”
Changing approaches to diagnosis and prevention
This new insight into the causes of Parkinson’s disease might change the way it is diagnosed and prevented in the future. According to Dr. Srinivasan, “Doctors could start examining for stomach problems, especially in at-risk people such as with a family history of Parkinson’s or chronic bowel complications.”
He adds, “By finding people with chronic constipation or gut inflammation and then watching them, it may be possible to develop effective early interventions that help stop the disease affecting the brain.” This might also result in changes in the approach to prevention, namely. The strategies are based on the maintenance of the gut through diet, probiotics, and other means as measures for lowering the risk of Parkinson’s.
Emerging treatments targeting the gut-brain axis
A particular emphasis is being placed on the treatment of the gut-brain axis, which is now starting to bear fruit. Dr Srinivasan notes, “Emerging treatments are now focusing the gut-brain axis as a target for Parkinson’s disease interventions. Probiotics and other therapies that affect gut microbes are being evaluated to improve intestinal health as a strategy to slow down disease progression by decreasing abnormal protein folding.”
Additionally, he notes that studies are being conducted on therapies that treat the gut as well as interventions that intercede with the vagus nerve through anti-inflammatory strategies. Though these treatments are still undergoing experimentation, initial studies have offered some hope.
In the words of Dr Srinivasan, “This expanding research from Harvard University and other institutions gives new possibilities for Parkinson’s patients as it highlights the importance of the gut in the progression of the disease. By tackling other clinical manifestations such as gastrointestinal symptoms at the onset, it might be able to change the course of the disease rather significantly.”
