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Increased attention should be given to detect GERD in PD. Gastrointestinal dysfunction is one of the most common nonmotor features of Parkinson’s disease (PD), from the original description by James Parkinson. Variable abnormalities from the mouth through the rectum are already known [2].

Finally, we performed multiple logistic regression analysis of PD with or without GERD. In the analysis, we used “1” to represent PD with GERD, males, and patients with the wearing-off phenomenon and “0” to represent PD without GERD, females, and patients without the wearing-off phenomenon. The other parameters were represented by their original values. The etiology of GERD still remains unclear; however, pathological research has provided some suggestive findings regarding the alimentary system. Lewy bodies in the extra central nervous system have been reported in Auerbach’s and Meissner’s plexuses by systemic pathological examination [12].

The results of the analysis comparing between PD with and without GERD suggested that GERD was clinically characterized by subjective heartburn and was more common in the advanced stage presenting with the wearing-off phenomenon. The analysis also suggested that GERD could cause deterioration of patients’ daily living activities and quality of life and that GERD was associated with the presence of other nonmotor symptoms. Furthermore, daily living activity and nonmotor symptoms can be independent relating factors of GERD in PD. These results suggest that GERD is a frequent nonmotor problem and a deteriorating factor of daily living activity in PD patients.

Nonmotor symptoms are troublesome for PD patients and physicians because conventional dopaminergic therapy does not always work efficiently in the management of these symptoms. Therefore, physicians should be alert for treatable symptoms. The diagnosis of GERD is commonly based on the history or findings from upper gastrointestinal endoscopy. As a therapeutic diagnostic method, 24 h esophageal pH monitoring combined with the PPI test [33] is also used. Because clinical history-based diagnosis is the simplest and quickest, demanding no additional workload of the patients, it is suitable for clinical practice.

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This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes.

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Reflux is another common problem that may precede the onset of pregnancy, begin with the onset of NVP, or worsen as the pregnancy progresses. Like NVP, the normal physiologic changes of pregnancy contribute to its development and often make management difficult.

In PD patients, disease duration and severity, quality of life, and nonmotor symptoms were also examined and then the clinical features of GERD were analyzed. A total of 102 patients and 49 controls were enrolled and 21 patients and 4 controls had heartburn, significantly frequent in PD. The prevalence rate of GERD was 26.5% in PD and the odds ratio was 4.05. Heartburn, bent forward flexion, and wearing-off phenomenon were frequent, and scores of UPDRS, total and part II, PD questionnaire-39, and nonmotor symptom scale were significantly higher in PD patients with GERD than without GERD. Multiple logistic regression analysis revealed statistical significance in UPDRS part II and nonmotor symptom scale.

Symptoms of autonomic dysfunction can impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient.

Variable symptoms in the alimentary system from the mouth to the anorectum have been reported [2]. Gastrointestinal problems are also a type of nonmotor symptoms. All parts of the gastrointestinal tract can be affected, even in the earlier phase of the disease course in some cases.

Dysphagia is relatively common and observed in 29%-80% of PD patients [2, 3], which can be induced by dyscoordination of various organs such as the mouth, pharynx, and esophagus. In addition to abnormalities of esophageal peristalsis, dysfunction in the lower esophageal sphincter can also produce clinical symptoms of gastroesophageal reflux [4-6]. Treatment of esophageal problems in PD still remains difficult. However, symptoms derived from gastroesophageal reflux can be treated with appropriate antireflux measures.

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