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Different gastrointestinal symptoms, such as excessive salivation, deterioration and other disorders affecting the teeth, dysphagia, gastroparesis, gastroesophageal reflux, constipation, difficult defecation or loss of weight are frequent events in all the stages of the development of Parkinson's disease and affect at least a third of the patients. These symptoms reflect the dysfunction of the enteric nervous system, and the stomach is one of the organs where alpha-synuclein is first deposited. Other factors, such as the dysfunction of structures in the central nervous system like the dorsal motor nucleus of the vagal nerve, hormonal factors or secondary effects deriving from the consumption of antiparkinsonian drugs, are involved in its origin. The present article offers a detailed review of the epidemiological, pathophysiological, clinical and therapeutic management aspects of the different gastrointestinal symptoms in Parkinson's disease.

This article discusses the most interesting studies on functional and motor gastrointestinal disorders presented at Digestive Diseases Week (DDW), 2015. Researchers are still seeking biomarkers for irritable bowel syndrome and have presented new data. One study confirmed that the use of low-dose antidepressants has an antinociceptive effect without altering the psychological features of patients with functional dyspepsia. A contribution that could have immediate application is the use of transcutaneous electroacupuncture, which has demonstrated effectiveness in controlling nausea in patients with gastroparesis. New data have come to light on the importance of diet in irritable bowel syndrome, although the effectiveness of a low-FODMAP diet seems to be losing momentum with time. Multiple data were presented on the long-term efficacy of rifaximin therapy in patients with irritable bowel syndrome and diarrhoea. In addition, among other contributions, and more as a curiosity, a study evaluated the effect of histamine in the diet of patients with irritable bowel syndrome., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Scleroderma is a chronic autoimmune disease of unknown cause characterized by fibrotic skin and multiple organs involvement, including the gastrointestinal tract. It occurs mainly in women between 35 and 65 years of age. It is classified as limited or diffuse based on the extent of skin involvement. Gastrointestinal dysmotility is observed in up to 90% of patients with a diffuse and limited scleroderma. It may involve any segment of the gastrointestinal tract from the esophagus to the anus and is related to collagen deposition at the level of enteric and vascular smooth muscle. Gastroparesis is a condition characterized by abnormal gastric motility, delay gastric emptying, in the absence of a mechanical obstruction to outflow. Gastric scintigraphy with radiolabeled solid food is the gold standard for the diagnosis of gastroparesis. Two cases of patients with systemic scleroderma and severe gastroparesis are presented in order to discuss the diagnostic and therapeutic approach, emphasizing the utility of gastric emptying scintigraphy.

We summarize and discuss the studies presented at the congress of the American Association of Gastroenterology (Digestive Disease Week) that, in our opinion, are of greatest interest. Both clinically and physiopathologically, functional gastrointestinal (GI) disorders are highly complex. A single cause is unlikely to explain symptoms as heterogeneous as those of functional dyspepsia and irritable bowel syndrome (IBS). Therefore, it is easier (and more useful) to try to understand functional GI disorders using a bio-psycho-social model. Moreover, data supporting the combined importance of genetic, organic and psychological factors in the onset and persistence of functional GI disorders are increasingly convincing. This year, new data have been provided on pharmacogenetics in gastroparesis, on microinflammation or alterations in the modulation of somatic and visceral sensitivity in functional dyspepsia, and on the impact of psychological factors in IBS. From the therapeutic point of view, further information has been provided on the role of probiotics, the antinociceptive effect of linaclotide (demonstrated in several studies presented this year), and on the high efficacy of hypnotherapy in patients with IBS. Finally, data on the clinical management of patients with constipation due to pelvic floor dyssynergia and on the safety and efficacy of prucalopride in patients with severe constipation were also of interest., (Copyright © 2012 Elsevier España, S.L. All rights reserved.)

This article discusses basic features of nutritional support in critically-ill patients: general indications, the route of administration and the optimal timing for the introduction of feeding. Although these features form the bedrock of nutritional support, most of the questions related to these issues are lacking answers based on the highest grade of evidence. Moreover, prospective randomized trials that might elucidate some o f these questions would probably be incompatible with good clinical practice. Nevertheless, nutritional support in critically-ill patients unable to voluntarily meet their own nutritional requirements is currently an unquestionable part of their treatment and care and is essential to the successful management of their illness., (Copyright © 2011 Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias (SEMICYUC) and Elsevier España, S.L. All rights reserved.)

Introduction: Constipation and gastric atony are two of the most important non-motor symptoms of the disease. The first is made significant by its high prevalence and precocity, since it may appear several years before the motor symptoms, and the second because of the repercussions it has on the absorption of oral medication used in this disease., Development: Both the symptoms and their possible treatment are reviewed., Conclusions: In both cases treatment is based on hygienic-dietary measures that avoid substances that reduce peristalsis, prokinetic drugs like domperidone and, sometimes, infiltration of botulinum toxin, electrical stimulation or even surgical treatment.

Introduction and Objective: Functional dyspepsia is a highly common disorder. The physiopathological mechanisms of this entity are not yet completely known and prokinetic drugs seem to be useful. The aim of this study was to evaluate the prokinetic effect of cinitapride in patients with dysmotility-like dyspepsia and delayed gastric emptying., Methods: Nineteen patients were randomized to receive 1mg of an oral solution of cinitapride t.i.d or placebo for 4 weeks in two consecutive periods, following a crossover and double-blind design. The main variable was the mean change from baseline after 4 weeks of treatment in gastric-emptying half-time after a liquid test meal, measured by real-time ultrasonography., Results: At the end of treatment, the mean gastric-emptying half-time decreased with both treatments, with no statistically significant differences between them (ANOVA, p=0.8720). This decrease was greater for cinitapride than for placebo (ANOVA, p=0.0169) in patients with mild-to-moderate delayed gastric emptying. In this group of patients, cinitapride was also superior to placebo in the percentage AUC of the antral area and the percentage of days free of nausea. Cinitapride was well tolerated, with a safety profile comparable to that of placebo., Conclusions: Oral cinitapride is safe and effective in improving gastric emptying and symptoms in patients with dysmotility-like dyspepsia and mild-to-moderate delayed gastric emptying.