Recent studies reported a high prevalence of small intestinal bacterial overgrowth (SIBO) in Parkinson's disease (PD), and a possible association with gastrointestinal symptoms and worse motor function. We aimed to study the prevalence and the potential impact of SIBO on gastrointestinal symptoms, motor function, and quality of life in a large cohort of PD patients.
103 Consecutive PD patients were assessed using the lactulose-hydrogen breath test; questionnaires of gastrointestinal symptoms and quality of life (PDQ-39); the Unified PD Rating Scale (UPDRS) including “on”-medication Part III (motor severity) score; and objective and quantitative measures of bradykinesia (Purdue Pegboard and timed test of gait). Patients and evaluating investigators were blind to SIBO status.
25.3% of PD patients were SIBO-positive. SIBO-positive patients had a shorter mean duration of PD (5.2 ± 4.1 vs. 8.1 ± 5.5 years, P = 0.007). After adjusting for disease duration, SIBO was significantly associated with lower constipation and tenesmus severity scores, but worse scores across a range of “on”-medication motor assessments (accounting for 4.2–9.0% of the variance in motor scores). There was no association between SIBO and motor fluctuations or PDQ-39 Summary Index scores.
This is the largest study to date on SIBO in PD. SIBO was detected in one quarter of patients, including patients recently diagnosed with the disease. SIBO was not associated with worse gastrointestinal symptoms, but independently predicted worse motor function. Properly designed treatment trials are needed to confirm a causal link between SIBO and worse motor function in PD.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Parkinsonism & Related Disorders
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Gastrointestinal dysfunction in Parkinson's disease.Parkinson Relat Disord. 2011; 17: 10-15
- Gastrointestinal dysfunction in Parkinson's disease.J Neurol Sci. 2010; 289: 69-73
- Overview of the extranigral aspects of Parkinson disease.Arch Neurol. 2009; 66: 167-172
- Beyond here be dragons: SIBO in Parkinson's disease.Mov Disord. 2013; 28: 1764-1765
- Small intestinal transit time in the elderly.Lancet. 1988; 331: 933
- Intestinal permeability and orocaecal transit time in elderly patients with Parkinson's disease.Postgrad Med J. 1996; 72: 164-167
- Prevalence of small intestinal bacterial overgrowth in Parkinson's disease.Mov Disord. 2011; 26: 889-892
- The role of small intestinal bacterial overgrowth in Parkinson's disease.Mov Disord. 2013; 28: 1241-1249https://doi.org/10.1002/mds.25522
- Leukocyte-subset counts in idiopathic parkinsonism provide clues to a pathogenic pathway involving small intestinal bacterial overgrowth. A surveillance study.Gut Pathog. 2012; 4: 12
- Antimicrobial surveillance in idiopathic parkinsonism: indication-specific improvement in hypokinesia following Helicobacter pylori eradication and non-specific effect of antimicrobials for other indications in worsening rigidity.Helicobacter. 2013; 18: 187-196
- Prevalence of small bowel bacterial overgrowth and its association with nutrition intake in nonhospitalized older adults.J Am Geriatr Soc. 2003; 51: 768-773
- Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth.Aliment Pharmacol Ther. 2010; 32: 1000-1006
- Diagnosis and management of small intestinal bacterial overgrowth.Nutr Clin Pract. 2013; 28: 289-299
- The relationship of Parkinson disease with aging.Arch Neurol. 2007; 64: 1242-1246
- Parkinson disease clinical subtypes and their implications.Nat Rev Neurol. 2011; 7: 247-248
- A systematic review of diagnostic tests for small intestinal bacterial overgrowth.Dig Dis Sci. 2008; 53: 1443-1454
- Diagnosis of small intestinal bacterial overgrowth: the challenges persist!.Expert Rev Gastroenterol Hepatol. 2009; 3: 77-87
- The concept of small intestinal bacterial overgrowth in relation to functional gastrointestinal disorders.Nutrition. 2010; 26: 1038-1043
- Benefits of breath hydrogen testing after lactulose administration in analysing carbohydrate malabsorption.Eur J Gastroenterol Hepatol. 2010; 22: 318-326
- Small intestinal bacterial overgrowth.World J Gastroenterol. 2010; 16: 2978-2990
- Small intestinal bacterial overgrowth: a comprehensive review.Gastroenterol Hepatol (N Y). 2007; 3: 112-122
- Increased incidence of small intestinal bacterial overgrowth during proton pump inhibitor therapy.Clin Gastroenterol Hepatol. 2010; 8: 504-508
- Gastrointestinal motility problems in patients with Parkinson's disease: effects of antiparkinsonian treatment and guidelines for management.Drugs Aging. 1997; 10: 249-258
- Reduced T helper and B lymphocytes in Parkinson's disease.J Neuroimmunol. 2012; 252: 95-99
- Lactose malabsorption in the elderly: role of small intestinal bacterial overgrowth.Scand J Gastroenterol. 2008; 43: 146-154
- Helicobacter pylori eradication and L-dopa absorption in patients with PD and motor fluctuations.Neurology. 2006; 66: 1824-1829
- Differential effect of Helicobacter pylori eradication on time-trends in brady/hypokinesia and rigidity in idiopathic parkinsonism.Helicobacter. 2010; 15: 279-294
- Increased intestinal permeability correlates with sigmoid mucosa alpha-synuclein staining and endotoxin exposure markers in early Parkinson's disease.PLoS ONE. 2011; 6: e28032https://doi.org/10.1371/journal.pone.0028032
- The impact of systemic infection on the progression of neurodegenerative disease.Nat Rev Neurosci. 2003; 4: 103-112
- Small intestinal bacterial overgrowth: roles of antibiotics, prebiotics and probiotics.Gastroenterology. 2006; 130: S78-S90
- Pharmacokinetics of levodopa.Clin Neuropharmacol. 1984; 7: 35-49
- Lymphocyte populations in Parkinson's disease and in rat models of parkinsonism.J Neuroimmunol. 2001; 113: 146-152
Published online: March 17, 2014
Accepted: February 19, 2014
Received in revised form: February 10, 2014
Received: November 26, 2013
© 2014 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.