Basic Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2016; 22(20): 4860-4867
Published online May 28, 2016. doi: 10.3748/wjg.v22.i20.4860
Gastric emptying, postprandial blood pressure, glycaemia and splanchnic flow in Parkinson’s disease
Laurence G Trahair, Thomas E Kimber, Katerina Flabouris, Michael Horowitz, Karen L Jones
Laurence G Trahair, Thomas E Kimber, Katerina Flabouris, Michael Horowitz, Karen L Jones, Discipline of Medicine, The University of Adelaide, Adelaide, SA 5000, Australia
Laurence G Trahair, Michael Horowitz, Karen L Jones, NHMRC Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5000, Australia
Thomas E Kimber, Neurology Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
Author contributions: Trahair LG, Kimber TE, Horowitz M and Jones KL were involved in the conception and design of the study, and drafted of the manuscript; Trahair LG and Kimber TE were also involved in coordination and subject recruitment; Trahair LG and Flabouris K collected data; Trahair LG, Horowitz M and Jones KL performed statistical analysis; all authors interpreted the data; Jones KL had overall responsibility for the study.
Supported by the Royal Adelaide Hospital, No. 13RAH1475; Australian Postgraduate Award and a Dawes scholarship from the Royal Adelaide Hospital (to Trahair LG); and NHMRC Senior Career Development Award (to Jones KL).
Institutional review board statement: The protocol was approved by the Research Ethics Committee, of the Royal Adelaide Hospital (approval number 111223).
Conflict-of-interest statement: Horowitz M has participated in the advisory boards and/or symposia for Novo Nordisk, Sanofi, Novartis, Eli Lilly, Merck Sharp and Dohme, Boehringer Ingelheim, and AstraZeneca and has received honoraria for this activity. None of the other authors has any personal or financial conflict of interest to declare.
Data sharing statement: Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Karen L Jones, NHMRC Senior CDA Research Fellow, Professor, Discipline of Medicine, The University of Adelaide, Level 6 Eleanor Harrald Building, Adelaide, SA 5000, Australia. karen.jones@adelaide.edu.au
Telephone: +61-8-82225394 Fax: +61-8-82233870
Received: November 23, 2015
Peer-review started: November 25, 2015
First decision: January 13, 2016
Revised: January 27, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: May 28, 2016
Abstract

AIM: To determine gastric emptying, blood pressure, mesenteric artery blood flow, and blood glucose responses to oral glucose in Parkinson’s disease.

METHODS: Twenty-one subjects (13 M, 8 F; age 64.2 ± 1.6 years) with mild to moderate Parkinson’s disease (Hoehn and Yahr score 1.4 ± 0.1, duration of known disease 6.3 ± 0.9 years) consumed a 75 g glucose drink, labelled with 20 MBq 99mTc-calcium phytate. Gastric emptying was quantified with scintigraphy, blood pressure and heart rate with an automated device, superior mesenteric artery blood flow by Doppler ultrasonography and blood glucose by glucometer for 180 min. Autonomic nerve function was evaluated with cardiovascular reflex tests and upper gastrointestinal symptoms by questionnaire.

RESULTS: The mean gastric half-emptying time was 106 ± 9.1 min, gastric emptying was abnormally delayed in 3 subjects (14%). Systolic and diastolic blood pressure fell (P < 0.001) and mesenteric blood flow and blood glucose (P < 0.001 for both) increased, following the drink. Three subjects (14%) had definite autonomic neuropathy and 8 (38%) had postprandial hypotension. There were no significant relationships between changes in blood pressure, heart rate or mesenteric artery blood flow with gastric emptying. Gastric emptying was related to the score for autonomic nerve function (R = 0.55, P < 0.01). There was an inverse relationship between the blood glucose at t = 30 min (R = -0.52, P < 0.05), while the blood glucose at t = 180 min was related directly (R = 0.49, P < 0.05), with gastric emptying.

CONCLUSION: In mild to moderate Parkinson’s disease, gastric emptying is related to autonomic dysfunction and a determinant of the glycaemic response to oral glucose.

Keywords: Gastric emptying, Hypotension, Parkinson’s disease, Blood pressure, Glucose

Core tip: We measured gastric emptying, blood pressure and blood glucose responses to a glucose drink in 21 patients with mild-to-moderate Parkinson’s disease. Gastric emptying was shown to be abnormally delayed 3 patients and 40% had postprandial hypotension - a fall in systolic blood pressure > 20 mmHg after the glucose drink. We demonstrated relationships between gastric emptying and autonomic dysfunction, so that slower gastric emptying was associated with greater autonomic dysfunction, as well as relationships between the blood glucose response with gastric emptying.