Marie Elisabeth Riechmann (born Spönemann), 1745 – 1807 Marie Elisabeth Riechmann (born Spönemann)
This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.
Healthy controls were also consecutively recruited. All the patients and controls were interviewed and neurologically examined and then confirmed as having no systemic or neurological disorder. Written informed consent to participate in this study was obtained from all the participants. In this study, we investigated the frequency and clinical features of GERD in PD.
The results of the analysis comparing between PD with and without GERD suggested that GERD was clinically characterized by subjective heartburn and was more common in the advanced stage presenting with the wearing-off phenomenon. The analysis also suggested that GERD could cause deterioration of patients’ daily living activities and quality of life and that GERD was associated with the presence of other nonmotor symptoms. Furthermore, daily living activity and nonmotor symptoms can be independent relating factors of GERD in PD. These results suggest that GERD is a frequent nonmotor problem and a deteriorating factor of daily living activity in PD patients.
Reflux is another common problem that may precede the onset of pregnancy, begin with the onset of NVP, or worsen as the pregnancy progresses. Like NVP, the normal physiologic changes of pregnancy contribute to its development and often make management difficult.
Variable symptoms in the alimentary system from the mouth to the anorectum have been reported . Gastrointestinal problems are also a type of nonmotor symptoms. All parts of the gastrointestinal tract can be affected, even in the earlier phase of the disease course in some cases.
The prevalence rate varies from 3% to 17.6% [19, 21-24]. We defined patients who had this postural abnormality, regardless of the degree of thoracolumbar flexion, and also complained of distress in their daily life because of the abnormal posture as having bent forward flexion because there are no unified and confirmed diagnostic criteria for abnormal posture in PD. In our study, the prevalence rate of bent forward flexion using this definition was relatively frequent compared with that in previous reports. test. Following this, we compared clinical characteristics of PD with or without GERD and examined the correlation of these characteristics with FSSG scores using Spearman’s rank correlation coefficient.
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 . A significant reduction in the FSSG score occurs in patients with both mild and severe GERD after therapy with PPI . 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.
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.
Helicobacter pylori (H. pylori) infection can induce motor fluctuations by interrupting the absorption of levodopa in PD patients [26-29]. Eradication of H.
Finally, we performed multiple logistic regression analysis of PD with or without GERD. In the analysis, we used “1” to represent PD with GERD, males, and patients with the wearing-off phenomenon and “0” to represent PD without GERD, females, and patients without the wearing-off phenomenon. The other parameters were represented by their original values. The etiology of GERD still remains unclear; however, pathological research has provided some suggestive findings regarding the alimentary system. Lewy bodies in the extra central nervous system have been reported in Auerbach’s and Meissner’s plexuses by systemic pathological examination .
In clinical practice, disappearance of these symptoms following treatment with proton pump inhibitors (PPIs) allows general physicians to reasonably conclude that the patient had acid-related dyspepsia . Dyspepsia is usually defined as upper abdominal pain or retrosternal pain, discomfort, heartburn, nausea, vomiting, or other symptoms considered to arise from the upper alimentary tract. When these symptoms cause deterioration of patients’ daily life quality, PPIs are generally used for treatment because they are more effective than histamine H2 receptor antagonists for reflux-like (heartburn) or ulcer-like (episodic epigastric pain) dyspepsia.
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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].