Probiotics Promising for Parkinson's Constipation

By Marilynn Larkin

October 22, 2020

NEW YORK (Reuters Health) - A multi-strain probiotics capsule effectively treated Parkinson's disease (PD)-related constipation in a short-term, single-center, randomized, controlled trial in Malaysia.

"With emerging evidence of a link between gut microbes and neurological disorders, including PD, treatments such as probiotics that can potentially modify the gut microbiome and its function have been a hot topic." Dr. Ai Huey Tan of the University of Malaya in Kuala Lumpur told Reuters Health by email. "While probiotics have been associated with a variety of health benefits, clinical trials of probiotics in patients with neurological disorders have been scarce, limiting the evidence-based usage of this treatment."

"Probiotics strains such as Lactobacillus and Bifidobacterium have a long history of safe use," he said. "There are, however, some potential caveats. One is a need for studies of longer duration, to determine whether probiotics maintain their effectiveness when used in the medium to longer term."

"An additional caveat, discussed briefly in our paper, is a theoretical concern of whether certain bacterial strains can have unintended effects, such reducing the absorption of levodopa medication used to treat PD symptoms. This is an area requiring further study," he said.

"For now," he added, "it does appear reasonable for patients to try probiotics as a means to improve constipation symptoms."

As reported in Neurology, Dr. Tan and colleagues randomized 72 patients (mean age, about 70; about 65% men) to a multi-strain probiotics capsule or placebo for four weeks. Each probiotic capsule contained 10 billion colony forming units of eight different commercially-available bacterial strains: Lactobacillus acidophilus, L. reuteri, L. gasseri, L. rhamnosus, Bifidobacterium bifidum, B. longum, Enterococcus faecalis, and E. faecium. The placebo group received capsules containing maltodextrin.

Quality of life related to constipation was assessed at baseline and at week four using the 28-item Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaire.

The primary endpoint was the change in the average number of spontaneous bowel movements (SBMs) per week during the last two weeks of the intervention, compared with the two-week pre-intervention phase.

SBMs increased by a mean of one per week after probiotics treatment, and decreased by 0.3 per week in the placebo group. After correction for multiple comparisons, significant improvements with probiotics were also seen for secondary outcomes, including stool consistency and quality of life related to constipation. A trend for reduced laxative usage was also seen.

Satisfaction was reported by 65.6% of intervention group participants versus 21.6% in the placebo group. One patient in the probiotics group became lethargic after starting treatment and dropped out after the first week.

Fecal calprotectin did not change significantly during the study.

Dr. Barbara Changizi, a neurologist at The Ohio State University Wexner Medical Center in Columbus who specializes in treating patients with PD and other movement disorders, commented in an email to Reuters Health, "Constipation is a significant detractor to quality of life in patients with PD. Constipation can lead to discomfort and nausea, and furthermore can prevent the gut's ability to absorb PD medications."

"The use of probiotics is a welcome tool in our arsenal to treat constipation," she said. "They are well tolerated and typically affordable, and could also work well with our other constipation drugs."

"One concern is that probiotics could lead to bacterial overgrowth in the gut," she noted. "This could result in bacteria (converting) levodopa to dopamine prematurely, before it enters the brain."

SOURCE: https://bit.ly/3kfWq2R Neurology, online October 12, 2020.

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