Hirokazu Doi

Plasma levodopa peak delay and impaired gastric emptying in Parkinson's disease

OBJECTIVES Whereas delayed gastric emptying is believed to be a causative factor for producing delayed-on and motor fluctuation in Parkinsons disease (PD), few studies have directly measured levodopa pharmacodynamics and gastric emptying together. In order to determine the relationship, we measured these two parameters in a single PD patients cohort. METHODS Thirty-one patients with PD were enrolled in the study. They were 11 men and 20 women; age, 68.1 ± 7.8 years; disease duration, 4.2 ± 3.8 years; Unified Parkinsons Disease Rating Scale Part 3 Motor Score 18.37 ± 8.60; bowel movement <3 times a week in 20; all taking 301 mg ± 94 mg/day levodopa/carbidopa. All patients underwent levodopa pharmacokinetic study and the gastric emptying study using (13)C-octanoic acid expiration breath test. Statistical analysis was performed by Students t-test and Mann-Whitneys U test. RESULTS Pharmacokinetic study showed that the plasma levodopa peak was at 2 hours in 42% (13/31 patients) whereas at 1 hour in 58% (18/31 patients), total of 50.7 ± 16.4 min (mean ± standard deviation) in all 31 patients. The gastric emptying study showed that T(max) ((13)C)>60 min was more common in patients with a plasma levodopa peak at 2 hours (14/18, 69%) than in those with a plasma levodopa peak at 1 hour (4/13, 22%) (p<0.05), total of 50.7 ± 16.4 min in all 31 patients. CONCLUSION We found a significant relationship between levodopa pharmacokinetics and gastric emptying in PD patients, suggesting that delayed gastric emptying is a causative factor for producing delayed-on in PD. Therefore, studies of improved gastric emptying in order to ameliorate delayed-on in PD are warranted.

Dietary Herb Extract Rikkunshi-To Ameliorates Gastroparesis in Parkinson's Disease: A Pilot Study

Objective: To perform an open trial on the effects of the extract of the dietary herb Rikkunshi-to (RKT) on gastroparesis in Parkinsons disease (PD) patients, using objective parameters given by the 13C-sodium acetate expiration breath test (gastric emptying study). Methods: Twenty patients with PD were enrolled into this study. Eleven patients were male and 9 were female, with the following characteristics (mean ± SD): age, 69.4 ± 8.17 years; disease duration, 4.34 ± 4.03 years; modified Hoehn and Yahr stage, 2.37 ± 0.98, and Unified Parkinsons Disease Rating Scale Part 3 motor score, 16.6 ± 7.37. Fourteen patients came to the clinic due to constipation; 16 patients were taking 288 ± 72 mg/day levodopa/carbidopa, 2 were taking dopamine agonists, and the others were not treated yet. All patients underwent the breath test. Statistical analysis was performed using Students t test. Results: RKT was well tolerated by all patients and none experienced abdominal pain or other adverse effects, except for its bitter taste. RKT significantly reduced the peak time of the 13C-dose-excess curve (p < 0.05). Conclusion: In this pilot trial, we found a significant shortening of the gastric emptying time after administration of the dietary herb extract RKT in PD patients. Further studies examining both gastric emptying and delayed-on in PD are warranted.

Nizatidine ameliorates gastroparesis in Parkinson's disease: a pilot study.

The objective of this work was to perform an open trial of the effects of nizatidine (NZT), a selective histamine H2‐receptor antagonist and a cholinomimetic, on gastroparesis in Parkinsons disease (PD) patients, using objective parameters given by a gastric emptying study using a 13C‐sodium acetate expiration breath test.

Nizatidine Ameliorates Slow Transit Constipation in Parkinson's Disease

To the Editor: Constipation (slow transit and anorectal types) is one of the most common nonmotor disorders in Parkinson’s disease (PD). Neuronal degeneration with alpha-synuclein-positive Lewy bodies appears in the myenteric plexus. Constipation leads to emergency intestinal pseudoobstruction, interferes with levodopa absorption, triggers malignant syndrome, and can appear earlier than motor disorder. Because slow-transit constipation is not responsive to levodopa, add-on therapies have been tried, with variable benefits. The results of a colonic transit time (CTT) test before and after administration of nizatidine, which acts on histamine H2 receptors, is presented. Inclusion criteria were PD and gastrointestinal tract (GIT) symptoms (upper: nausea, postprandial bloating; lower: bowel movement <3 times a week, difficult defecation) (12 participants complained of constipation). Individ-

Levodopa Does Not Worsen Gastric Emptying in Parkinson's Disease.

pneumonia severity on presentation to hospital: An international derivation and validation study. Thorax 2003;58:377–382. 5. Miyashita N, Matsushima T, Oka M et al. The JRS guidelines for the management of community-acquired pneumonia in adults: An update and new recommendations. Intern Med 2006;45:419–428. 6. Shigematsu K, Nakano H, Watanabe Y. The eye response test alone is sufficient to predict stroke outcome—reintroduction of Japan Coma Scale: A cohort study. BMJ Open 2013;e002736. doi: 10.1136/bmjopen-2013002736. 7. Cruz-Jentoft AJ, Baeyens JP, Bauer JM et al. Sarcopenia: European consensus on definition and diagnosis: Report of the European Working Group on Sarcopenia in Older People. Age Ageing 2010;39:412–423. 8. Kuroda Y, Kuroda R. Relationship between thinness and swallowing function in Japanese older adults: Implications for sarcopenic dysphagia. J Am Geriatr Soc 2012;60:1785–1786. 9. Wakabayashi H. Presbyphagia and sarcopenic dysphagia: Association between aging, sarcopenia, and deglutition disorders. J Frailty Aging 2014;3:97–103. 10. Maeda K, Akagi J. Decreased tongue pressure is associated with sarcopenia and sarcopenic dysphagia in the elderly. Dysphagia 2015;30:80–87.

Transdermal Dopamine Agonist Ameliorates Gastric Emptying in Parkinson's Disease.

This research is supported by Grant T15LM007442 from the National Library of Medicine. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: Chaudhuri: study design, recruitment, data collection, preparation of manuscript. Oudejans: data analysis and interpretation. Thompson, Demiris: study design, assisting primary author throughout the study, data interpretation, preparation of final manuscript. Sponsor’s Role: None.

Gatrointestinal dysfunction in dementia with lewy bodies: A comparison with Parkinson’s disease

Results 1) gastric emptying: Tmax (the peak time of the C-dose-excess curve, normal 45min; Tmax >75 min is regarded marked) of DLB group (63.2 min) was significantly prolonged than that of PD group (52.3 min) (p<0.05). Similarly, percent marked (>75 min) cases in DLB group (42.1%) was significantly larger than that of PD group (15.2%) (p<0.05). 2) CTT: CTT was not different significantly between both groups (data not shown).

Mild Cognitive Impairment as the Initial Manifestation of Progressive Supranuclear Palsy.

thoracic cavity (Figure 1B), providing a diagnosis of esophageal rupture. The patient underwent emergency surgery. The rupture was detected in the lower esophagus and was sutured successfully. He recovered gradually and was eventually discharged 2 months after the surgery. Elderly adults are reported to have a higher risk of complications during and after colonoscopy, but it is unknown whether esophageal perforation during colonoscopy preparation is associated with age. Esophageal perforation is a life-threatening condition, and mortality is high (11.9%) despite of surgical or medical treatment. Although there are several causes of esophageal perforation, only a few spontaneous esophageal perforation cases associated with PEG electrolyte solution for colonoscopy preparation have been reported. These previous reports and the present case suggested that esophageal rupture during colonoscopy preparation might be common in elderly adults (median 73, range 61–85). Therefore, clinicians should be aware of this potentially lethal complication of routine preparation for colonoscopy, especially in elderly adults.