Clinical implications of gastric complications on levodopa treatment in Parkinson’s disease
Open accessAbstract
Disorders of the gastrointestinal (GI) tract are common and distressing nonmotor symptoms of Parkinson's disease (PD) that can adversely affect levodopa absorption and lead to OFF periods, also known as motor fluctuations. Gastroparesis, which is primarily defined as delayed gastric emptying (DGE), and Helicobacter pylori infection, which is present with increased frequency in PD, are among the most common and important GI disorders reported in PD that may impair oral levodopa absorption and increase OFF time. Symptoms of gastroparesis include nausea, vomiting, postprandial bloating, fullness, early satiety, abdominal pain, and weight loss. DGE has been reported in a substantial fraction of individuals with PD. Symptoms of H. pylori infection include gastritis and peptic ulcers. Studies have found that DGE and H. pylori infection are correlated with delayed peak levodopa plasma levels and increased incidence of motor fluctuations. Therapeutic strategies devised to minimize the potential that gastric complications will impair oral levodopa absorption and efficacy in PD patients include treatments that circumvent the GI tract, such as apomorphine injection, levodopa intestinal gel delivery, levodopa inhalation powder, and deep brain stimulation. Other strategies aim at improving gastric emptying in PD patients, primarily including prokinetic agents.
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Gastric motor dysfunction can impair levodopa pharmacokinetics and contribute to motor fluctuations in Parkinson disease.
“Gastric motor dysfunction can impair levodopa pharmacokinetics and contribute to motor fluctuations (Pfeiffer et al., 2020); systematic reviews support the association between PD and gastroparesis (Heetun et al., 2012).”
From Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction (2026) · cites this paper as Pfeiffer et al., 2020
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Autonomic nervous system and gastrointestinal manifestations with an emphasis on gastric dysfunction
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- Authors
- Pfeiffer, R. F., Isaacson, S. H., & Pahwa, R.
- Affiliations
- Oregon Health & Science University (US)
- University of Kansas Medical Center (US)
- Corresponding author
- Pfeiffer, Ronald F.
- Venue
- Parkinsonism & Related Disorders
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 76
- Pages
- 63-71
- ISSN
- 1353-8020 (ISSN-L)
- OpenAlex
- W3024931781
- Cited by
- 77
- References
- 13
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 11 · 2023: 18 · 2022: 12 · 2021: 8 · 2020: 2
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Parkinsonism & Related Disorders (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Funders
- Acorda Therapeutics
- Topics
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Neurology › Neurological disorders and treatments
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- Parkinson's disease, levodopa
- MeSH terms
- Antiparkinson Agents, Gastritis, Humans, Levodopa, Parkinson Disease, Peptic Ulcer, Helicobacter Infections, Gastroparesis
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