In the vast realm of Parkinson’s disease, gastrointestinal (GI) issues lurk like hidden obstacles. While constipation takes the spotlight, dysphagia and gastroparesis often operate in the shadows, overlooked and underestimated. Yet, these upper GI problems can wreak havoc on patients’ well-being and disrupt the efficacy of oral PD medications. To achieve comprehensive care for Parkinson’s, addressing dysphagia and gastroparesis promptly is crucial. A combination of non-pharmacological and pharmacological approaches provides a powerful duo, considering that medication alone may fall short. Unfortunately, resource limitations may hinder the multidisciplinary teamwork ideal for managing GI issues in PD. Consequently, neurologists and PD care teams bear the responsibility of initial assessments and treatment or referral recommendations. To support these decisions, this article examines diagnostic and therapeutic strategies for dysphagia and gastroparesis, stressing the importance of timely referrals to GI specialists when necessary and offering guidance in crafting effective management plans.

Gastrointestinal (GI) issues are commonly experienced by patients with Parkinson’s disease (PD). Those that affect the lower GI tract, such as constipation, are the most frequently reported GI problems among patients with PD. Upper GI issues, such as swallowing dysfunction (dysphagia) and delayed gastric emptying (gastroparesis), are also common in PD but are less well recognized by both patients and clinicians and, therefore, often overlooked. These GI issues may also be perceived by the healthcare team as less of a priority than management of PD motor symptoms. However, if left untreated, both dysphagia and gastroparesis can have a significant impact on the quality of life of patients with PD and on the effectiveness on oral PD medications, with negative consequences for motor control. Holistic management of PD should therefore include timely and effective management of upper GI issues by utilizing both non-pharmacological and pharmacological approaches. This dual approach is key as many pharmacological strategies have limited efficacy in this setting, so non-pharmacological approaches are often the best option. Although a multidisciplinary approach to the management of GI issues in PD is ideal, resource constraints may mean this is not always feasible. In ‘real-world’ practice, neurologists and PD care teams often need to make initial assessments and treatment or referral recommendations for their patients with PD who are experiencing these problems. To provide guidance in these cases, this article reviews the published evidence for diagnostic and therapeutic management of dysphagia and gastroparesis, including recommendations for timely and appropriate referral to GI specialists when needed and guidance on the development of an effective management plan.

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