October 12, 2016
TAKE-HOME MESSAGE
- “Constipation is extremely common in Parkinson’s disease, and quite difficult to manage, particularly in late disease stages. Disruption in the intestinal biostasis has been shown in Parkinson’s disease, and, based on these findings, as well as smaller prior attempts, the authors conducted a randomized, parallel-group, double-blind, placebo-controlled clinical trial of a probiotic compound consisting of fermented milk containing multiple probiotic strains and prebiotic fiber, compared with a placebo (pasteurized, fermented, fiber-free milk). The active compound resulted in an increase in the number of weekly complete bowel movements of 1.2, compared with 0.1 with placebo. Adherence to therapy was high, and 1 patient in each group reported abdominal distension and bloating. The results suggest a beneficial effect, albeit of relatively small magnitude, of this prebiotic/probiotic formulation. Some concerns include the continued use of concomitant laxatives during the trial and the generalization of the results, given the specifics of the formulation used.” – Codrin I Lungu, MD
- In patients with Parkinson’s disease who have constipation, an improvement in the frequency of complete bowel movements results from receiving an intervention of probiotics and prebiotic fiber–supplemented fermented milk.
Abstract
OBJECTIVES
Our objective was to evaluate the efficacy of probiotics and prebiotics in patients with Parkinson disease (PD) and constipation.
METHODS
We conducted a tertiary setting, randomized, double-blind, placebo-controlled trial in patients with PD with Rome III-confirmed constipation based on 2-week stool diary data at baseline. Patients (n = 120) were randomly assigned (2:1) to either a fermented milk, containing multiple probiotic strains and prebiotic fiber, or placebo, once daily for 4 weeks. The primary efficacy endpoint was the increase in the number of complete bowel movements (CBMs) per week. The key secondary endpoints were 3 or more CBMs and an increase by one or more CBMs per week during weeks 3 and 4.
RESULTS
For the primary endpoint, the consumption of a fermented milk containing probiotics and prebiotics resulted in a higher increase in the number of CBMs (mean 1.2, 95% confidence interval [CI] 0.8-1.6) than placebo (0.1, 95% CI -0.4% to 0.6%) (mean difference 1.1, 95% CI 0.4-1.8; p = 0.002). For the key secondary endpoints, a higher number of patients in the probiotics-prebiotics group vs the placebo group reported 3 or more CBMs (p = 0.030; 58.8% vs 37.5%; odds ratio = 2.4, 95% CI 1.1-5.2) and an increase by one or more CBMs (p = 0.004; 53.8% vs 25.0%; odds ratio = 3.5, 95% CI 1.8-8.1) during weeks 3 and 4.
CONCLUSIONS
The consumption of a fermented milk containing multiple probiotic strains and prebiotic fiber was superior to placebo in improving constipation in patients with PD.