Table 2 Summary of most relevant clinical manifestations of upper GIT impairment and feasible treatment approaches.
From: Gastrointestinal involvement in Parkinson’s disease: pathophysiology, diagnosis, and management
Symptom | Pharmacotherapy | Swallowing therapy by Speech language therapists |
|---|---|---|
Oropharyngeal freezing: | Increase dose of L-dopa before meal times Amantadine? | Triggering of swallowing reflex External triggers? |
Premature spillage: | Oral bolus control Avoid dual tasks | |
Penetration/Aspiration: | Non-oral delivery: patch or pump? | Protective reflexes Sensory stimulation Supraglottic swallow maneuver Safe food consistencies? PEG? |
Pharyngeal residues without motor fluctuations: | Individual assessment of L-dopa responsiveness, if positive: Increase dose of L-dopa before meals | Effortful swallow exercise |
Pharyngeal residues without motor fluctuations: | Individual assessment of L-dopa responsiveness, if positive: Optimize oral treatment Non-oral delivery: patch or pump? | Meal times during on state condition Effortful swallow exercise in off state condition |
Esophageal spasms: | Non-oral delivery: patch or pump? Botulinum toxin injections into upper esophageal sphincter? | Protective reflexes Mendelsohn swallow exercise Safe food consistencies? PEG? |
