Gastrointestinal dysfunction in neurological disease

BACKGROUND - Patients with neuromuscular disease often present with symptoms of gastrointestinal (GI) dysfunction. These GI complications can be life-threatening, but with appropriate therapy, debilitating symptoms can be ameliorated and further deterioration prevented. REVIEW SUMMARY - Symptoms of nausea and vomiting, early satiety, bloating, and abdominal pain in patients with diseases such as Parkinson's disease, diabetes mellitus, and scleroderma suggest the need for a careful clinical evaluation, followed, if necessary, by an upper GI series, endoscopy of the GI tract, and gastric scintigraphy to confirm the cause of the gastropathy. A gut dysmotility disorder such as delayed gastric emptying is a common and serious sequela of neurologic disease. Treatment comprises dietary modifications, drug therapy, and, in severe refractory cases, endoscopic and surgical interventions. Although both domperidone and metoclopramide are effective symptomatic therapies, domperidone rarely induces the extrapyramidal reactions often seen with metoclopramide. CONCLUSION - GI complications are often overlooked in patients with neurologic disease. However, early diagnosis and appropriate intervention can reduce morbidity and improve patients' quality of life.