The treatment of gastroparesis, constipation and small intestinal bacterial overgrowth syndrome in patients with Parkinson's disease

Expert Opin Pharmacother. 2015;16(16):2449-64. doi: 10.1517/14656566.2015.1086747. Epub 2015 Sep 16.


Introduction: Parkinson's disease (PD) affects the nerves of the entire gastrointestinal (GI) tract and may result in profound gastrointestinal (GI) dysfunction leading to poor patient outcomes. Common GI disturbances in patients with PD include gastroparesis (GP), constipation and small intestinal bacterial overgrowth syndrome (SIBO). In particular, GP is difficult to treat due to the limited options available and precautions, contraindications and adverse effects associated with the approved treatments. Moreover, some commonly used medications can worsen pre-existing PD.

Areas covered: Our review will focus on treatment options for GP and SIBO with motilin agonists, dopamine receptor antagonists, Ghrelin agonists muscarinic agonists, 5-HT4 receptor agonists, antibiotics, probiotics and herbal formulation such as iberogast. Constipation occurs in the majority of patients with PD and fortunately many treatments are now available. Our review is based on original papers or reviews selected from PUBMED search and Cochrane reviews.

Expert opinion: Motility disorders of the GI tract are found frequently in patients with PD and treating the underlying GI disorders caused by PD with various prokinetics and laxatives is paramount in achieving improvements in patient's motor function. Various prokinetics and laxatives are now available to provide some relief of the GI morbidity caused by PD leading even to better absorption of even the PD treatments.

Keywords: 5-HT4 receptor agonists; PEG; Parkinson’s disease; RM-131; STW5; TZP-101; TZP-102; autonomic nervous system dysfunction; azithromycin; constipation; domperidone; dysmotility; erythromycin; gastrointestinal; gastroparesis; iberogast; linaclotide; lubiprostone; mosapride; nizatidine; non-motor symptoms; probiotics; prucalopride; rifaximin; small intestinal bacterial overgrowth syndrome; ulimorelin.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Blind Loop Syndrome / complications
  • Blind Loop Syndrome / drug therapy*
  • Blind Loop Syndrome / epidemiology
  • Constipation / complications
  • Constipation / drug therapy*
  • Constipation / epidemiology
  • Dopamine Antagonists / therapeutic use
  • Gastroparesis / complications
  • Gastroparesis / drug therapy*
  • Gastroparesis / epidemiology
  • Humans
  • Laxatives / therapeutic use
  • Muscarinic Agonists / therapeutic use
  • Parkinson Disease / complications
  • Parkinson Disease / drug therapy*
  • Parkinson Disease / physiopathology
  • Plant Extracts / therapeutic use
  • Probiotics / therapeutic use
  • Serotonin 5-HT4 Receptor Agonists / therapeutic use


  • Anti-Bacterial Agents
  • Dopamine Antagonists
  • Laxatives
  • Muscarinic Agonists
  • Plant Extracts
  • Serotonin 5-HT4 Receptor Agonists
  • iberogast