Parkinson Disease Risk Elevated in Patients With Upper GI Mucosal Damage
A history of upper gastrointestinal mucosal damage is associated with a 76% increased risk of subsequent Parkinson disease (PD), according to a study published online in JAMA Network Open.
“These findings highlight the necessity for heightened monitoring of patients with MD [mucosal damage] given their increased clinical PD susceptibility and the importance of establishing gut biomarkers,” wrote corresponding author Trisha S. Pasricha, MD, MPH, of Beth Israel Deaconess Medical Center, Boston, Massachusetts, and study coauthors.
Results from epidemiological studies have implied possible links between Helicobacter pylori infection, mucosal damage, and PD, researchers explained. In this study, they investigated whether upper gastrointestinal mucosal damage from any source is associated with a higher risk of PD.
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The retrospective cohort study included 9350 patients from the Mass General Brigham system, Boston, Massachusetts, who underwent upper endoscopy with biopsy between January 2000 and December 2005 and were followed through July 2023. Researchers matched 2337 patients with mucosal damage 1:3 with 7013 patients without mucosal damage for age, sex, and date of initial endoscopy.
The majority of patients were male (55.4%) and were an average 52.3 years of age when they underwent endoscopy. Patients with mucosal damage at baseline were more likely to have a history of H pylori infection, proton-pump inhibitor use, chronic nonsteroidal anti-inflammatory drug use, gastroesophageal reflux disease, smoking, constipation, and dysphagia.
Over a mean follow-up of 14.9 years, 2.2% of patients with mucosal damage and 0.5% of patients without mucosal damage were diagnosed with PD, the study found. Researchers reported an incident rate ratio of 4.15 and, after adjustment for multiple covariates, a hazard ratio of 1.76 for the risk of PD in patients with, compared with patients without, mucosal damage.
Other factors linked with a higher risk of subsequent PD included constipation, dysphagia, older age, and higher Charlson-Deyo Comorbidity Index, according to the study.
“The findings of our investigation corroborate our hypothesis that upper gastrointestinal MD would be associated with clinical PD development,” researchers wrote, “reinforcing the theory of a gut-first progression in PD in a subset of patients.”
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