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Long-Term Risks of Parkinson’s Disease, Surgery, and Colorectal Cancer in Patients With Slow-Transit Constipation

Published:August 31, 2020DOI:https://doi.org/10.1016/j.cgh.2020.08.059

      Background & Aims

      Long-term outcomes of constipation have not been evaluated fully. We investigated the incidence of Parkinson’s disease, constipation-related surgery, and colorectal cancer (CRC) in patients with constipation and slow-transit constipation (STC), followed up for up to 20 years.

      Methods

      We collected data from 2165 patients (33.1% men; median patient age, 54 y; median symptom duration, 5.0 y) with a diagnosis of constipation (based on Rome II criteria) who underwent an anorectal function test and a colonic transit time study, from 2000 through 2010, at a tertiary university hospital in Seoul, South Korea. The presence of STC was determined from colonic transit time. We used the Kaplan–Meier method to analyze and compare cumulative probabilities of a new diagnosis of Parkinson’s disease or CRC according to the presence of STC. The patients were followed up until the end of 2019.

      Results

      During a median follow-up period of 4.7 years (interquartile range, 0.7–8.3 y), 10 patients underwent constipation-related surgery. The cumulative probabilities of constipation-related surgery were 0.7% at 5 years and 0.8% at 10 years after a diagnosis of constipation. Twenty-nine patients (1.3%) developed Parkinson’s disease; the cumulative probabilities were 0.4% at 1 year, 1.0% at 5 years, and 2.6% at 10 years after a diagnosis of constipation. At 10 years, 1.3% of patients with STC required constipation-related surgery and 3.5% of patients with STC developed Parkinson’s disease; in contrast, none of the patients without STC required constipation-related surgery (P = .003), and 1.5% developed Parkinson’s disease (P = .019). In multivariate analysis, patient age of 65 years or older at the diagnosis of constipation (hazard ratio, 4.834; 95% CI, 2.088–11.190) and the presence of STC (hazard ratio, 2.477; 95% CI, 1.046–5.866) were associated independently with the development of Parkinson’s disease. Only 5 patients had a new diagnosis of CRC during the follow-up period. The risk of CRC did not differ significantly between patients with vs without STC (P = .575).

      Conclusions

      In a long-term follow-up study of patients with constipation in Korea, most patients had no severe complications. However, patients older than age 65 years with a new diagnosis of STC might be considered for Parkinson’s disease screening.

      Graphical abstract

      Keywords

      Abbreviations used in this paper:

      CRC (colorectal cancer), CTT (colonic transit time study), DD (dyssynergic defecation), IQR (interquartile range), PD (Parkinson’s disease), STC (slow-transit constipation)
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      References

        • Suares N.C.
        • Ford A.C.
        Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis.
        Am J Gastroenterol. 2011; 106 (quiz 1, 92): 1582-1591
        • Bharucha A.E.
        • Pemberton J.H.
        • Locke 3rd, G.R.
        American Gastroenterological Association technical review on constipation.
        Gastroenterology. 2013; 144: 218-238
        • Knowles C.H.
        • Scott M.
        • Lunniss P.J.
        Outcome of colectomy for slow transit constipation.
        Ann Surg. 1999; 230: 627-638
        • Pemberton J.H.
        • Rath D.M.
        • Ilstrup D.M.
        Evaluation and surgical treatment of severe chronic constipation.
        Ann Surg. 1991; 214 (discussion 11–13): 403-411
        • Guerin A.
        • Mody R.
        • Fok B.
        • et al.
        Risk of developing colorectal cancer and benign colorectal neoplasm in patients with chronic constipation.
        Aliment Pharmacol Ther. 2014; 40: 83-92
        • Lin C.H.
        • Lin J.W.
        • Liu Y.C.
        • et al.
        Risk of Parkinson's disease following severe constipation: a nationwide population-based cohort study.
        Parkinsonism Relat Disord. 2014; 20: 1371-1375
        • Adams-Carr K.L.
        • Bestwick J.P.
        • Shribman S.
        • et al.
        Constipation preceding Parkinson's disease: a systematic review and meta-analysis.
        J Neurol Neurosurg Psychiatry. 2016; 87: 710-716
        • Bharucha A.E.
        • Dorn S.D.
        • Lembo A.
        • et al.
        American Gastroenterological Association medical position statement on constipation.
        Gastroenterology. 2013; 144: 211-217
        • Bharucha A.E.
        • Philips S.F.
        Slow-transit constipation.
        Curr Treat Options Gastroenterol. 2001; 4: 309-315
        • Rao S.S.
        Dyssynergic defecation and biofeedback therapy.
        Gastroenterol Clin North Am. 2008; 37 (viii): 569-586
        • Rao S.S.
        Biofeedback therapy for constipation in adults.
        Best Pract Res Clin Gastroenterol. 2011; 25: 159-166
        • Lee H.J.
        • Boo S.J.
        • Jung K.W.
        • et al.
        Long-term efficacy of biofeedback therapy in patients with dyssynergic defecation: results of a median 44 months follow-up.
        Neurogastroenterol Motil. 2015; 27: 787-795
        • Lee H.J.
        • Jung K.W.
        • Myung S.J.
        Technique of functional and motility test: how to perform biofeedback for constipation and fecal incontinence.
        J Neurogastroenterol Motil. 2013; 19: 532-537
        • Rao S.S.
        • Rattanakovit K.
        • Patcharatrakul T.
        Diagnosis and management of chronic constipation in adults.
        Nat Rev Gastroenterol Hepatol. 2016; 13: 295-305
        • Kim J.
        • Myung S.-J.
        • Yang D.-H.
        • et al.
        Clinical characteristics of constipation with hypothyroidism.
        Intestinal Res. 2010; 8: 48-57
        • Herve S.
        • Savoye G.
        • Behbahani A.
        • et al.
        Results of 24-h manometric recording of colonic motor activity with endoluminal instillation of bisacodyl in patients with severe chronic slow transit constipation.
        Neurogastroenterol Motil. 2004; 16: 397-402
        • Rao S.S.
        • Seaton K.
        • Miller M.J.
        • et al.
        Psychological profiles and quality of life differ between patients with dyssynergia and those with slow transit constipation.
        J Psychosom Res. 2007; 63: 441-449
        • Thompson W.G.
        • Longstreth G.F.
        • Drossman D.A.
        • et al.
        Functional bowel disorders and functional abdominal pain.
        Gut. 1999; 45: Ii43-Ii47
        • Yik Y.I.
        • Clarke M.C.
        • Catto-Smith A.G.
        • et al.
        Slow-transit constipation with concurrent upper gastrointestinal dysmotility and its response to transcutaneous electrical stimulation.
        Pediatr Surg Int. 2011; 27: 705-711
        • Gibb W.R.
        • Lees A.J.
        The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease.
        J Neurol Neurosurg Psychiatry. 1988; 51: 745-752
        • Kim J.E.
        • Rhee P.L.
        • Kim Y.H.
        • et al.
        Clinical usefulness of KolomarkTM, a Korean radio-opaque marker for measuring colon transit time.
        Korean J Med. 2001; 60: 337-341
        • Minguez M.
        • Herreros B.
        • Sanchiz V.
        • et al.
        Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation.
        Gastroenterology. 2004; 126: 57-62
        • Metcalf A.M.
        • Phillips S.F.
        • Zinsmeister A.R.
        • et al.
        Simplified assessment of segmental colonic transit.
        Gastroenterology. 1987; 92: 40-47
        • Staller K.
        • Barshop K.
        • Ananthakrishnan A.N.
        • et al.
        Rectosigmoid localization of radiopaque markers does not correlate with prolonged balloon expulsion in chronic constipation: results from a multicenter cohort.
        Am J Gastroenterol. 2015; 110: 1049-1055
        • Lyford G.L.
        • He C.L.
        • Soffer E.
        • et al.
        Pan-colonic decrease in interstitial cells of Cajal in patients with slow transit constipation.
        Gut. 2002; 51: 496-501
        • He C.L.
        • Burgart L.
        • Wang L.
        • et al.
        Decreased interstitial cell of Cajal volume in patients with slow-transit constipation.
        Gastroenterology. 2000; 118: 14-21
        • Mollen R.M.
        • Hopman W.P.
        • Kuijpers H.H.
        • et al.
        Abnormalities of upper gut motility in patients with slow-transit constipation.
        Eur J Gastroenterol Hepatol. 1999; 11: 701-708
        • Bassotti G.
        • Maggio D.
        • Battaglia E.
        • et al.
        Manometric investigation of anorectal function in early and late stage Parkinson's disease.
        J Neurol Neurosurg Psychiatry. 2000; 68: 768-770
        • Edwards L.L.
        • Pfeiffer R.F.
        • Quigley E.M.
        • et al.
        Gastrointestinal symptoms in Parkinson's disease.
        Mov Disord. 1991; 6: 151-156
        • Pfeiffer R.F.
        Gastrointestinal dysfunction in Parkinson's disease.
        Parkinsonism Relat Disord. 2011; 17: 10-15
        • Su A.
        • Gandhy R.
        • Barlow C.
        • et al.
        Utility of high-resolution anorectal manometry and wireless motility capsule in the evaluation of patients with Parkinson's disease and chronic constipation.
        BMJ Open Gastroenterol. 2016; 3e000118
        • Natale G.
        • Pasquali L.
        • Ruggieri S.
        • et al.
        Parkinson's disease and the gut: a well known clinical association in need of an effective cure and explanation.
        Neurogastroenterol Motil. 2008; 20: 741-749
        • Dukas L.
        • Willett W.C.
        • Colditz G.A.
        • et al.
        Prospective study of bowel movement, laxative use, and risk of colorectal cancer among women.
        Am J Epidemiol. 2000; 151: 958-964
        • Jung K.W.
        • Won Y.J.
        • Oh C.M.
        • et al.
        Prediction of cancer incidence and mortality in Korea, 2017.
        Cancer Res Treat. 2017; 49: 306-312
        • Shin A.
        • Jung K.W.
        • Woo H.
        • et al.
        Colorectal cancer incidence in Korea is not the highest in the world.
        Cancer Res Treat. 2016; 48: 864-867

      References

        • Metcalf A.M.
        • Phillips S.F.
        • Zinsmeister A.R.
        • et al.
        Simplified assessment of segmental colonic transit.
        Gastroenterology. 1987; 92: 40-47
        • Arhan P.
        • Devroede G.
        • Jehannin B.
        • et al.
        Segmental colonic transit time.
        Dis Colon Rectum. 1981; 24: 625-629
        • Schey R.
        • Cromwell J.
        • Rao S.S.
        Medical and surgical management of pelvic floor disorders affecting defecation.
        Am J Gastroenterol. 2012; 107 (quiz p.34): 1624-1633
        • Minguez M.
        • Herreros B.
        • Sanchiz V.
        • et al.
        Predictive value of the balloon expulsion test for excluding the diagnosis of pelvic floor dyssynergia in constipation.
        Gastroenterology. 2004; 126: 57-62
        • Kim A.Y.
        How to interpret a functional or motility test - defecography.
        J Neurogastroenterol Motil. 2011; 17: 416-420