Multi-Strain Probiotic Reduces Constipation in Parkinson Disease

A multi-strain probiotic consisting of 8 different commercially available bacterial strains reduced constipation in patients with Parkinson Disease (PD), according to study results published in Neurology.

Constipation is a commonly challenging problem to treat in patients with PD. Study researchers sought to assess whether probiotics were effective for this issue.

This double-blind trial enrolled 280 patients with PD from a neurology outpatient clinic at a single university center in Malaysia. A total of 72 eligible patients were randomly assigned to receive either a multi-strain probiotic (n=34) or a placebo (n=38) for 4 weeks. The multi-strain probiotic capsule contained 10 billion colony forming units consisting of Lactobacillus acidophilus, Lactobacillus reuteri, Lactobacillus gasseri, Lactobacillus rhamnosus, Bifidobacterium bifidum, Bifidobacterium longum, Enterococcus faecalis, and Enterococcus faecium.

The study researchers looked for the change in the mean number of spontaneous bowel movements (SBM) per week during the last 2 weeks of treatment compared with the 2 weeks prior to treatment. A daily stool diary was used to examine this primary endpoint. Additional secondary outcomes included changes in stool consistency, constipation severity score, and quality of life related to constipation.

A significant increase in SBM of 1.0±1.2 per week was observed after probiotic treatment compared with a decrease of 0.3±1.0 SBM per week with placebo (mean difference, 1.3; 95% CI, 0.8-1.8; P <.001). Significantly greater improvements were observed in the probiotic group compared with the placebo group for stool consistency (mean change, -0.8±1.4 vs 0.0±0.8, respectively; mean difference, -0.9; 95% CI, -1.5 to -0.3; P =.009) and quality of life associated with constipation (mean change, -0.6±0.6 vs -0.2±0.4; mean difference, -0.4; 95% CI, -0.6 to -0.1; P =.001).

Approximately 65.6% of patients in the probiotic group reported satisfaction related to their treatment compared with 21.6% of the patients randomly assigned to placebo (P <.001). Only 2.9% (n=1) of patients in the treatment group withdrew from the study because of a non-serious adverse event. There was no significant change in fecal calprotectin during the study.

Limitations of this study included the short treatment duration, the relatively small number of included patients, the inability to completely halt patient laxative use, and the study’s single-center design.

The study researchers added that future research could provide “elucidation of the mechanisms of probiotics action,” which may “also pave the way for a more personalized approach, rather than empirical ‘one-size-fits-all’ regimens.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference Tan AH, Lim SY, Chong KK, et al. Probiotics for constipation in Parkinson’s disease: A randomized placebo-controlled study. Neurology. Published online October 12, 2020. doi:10.1212/WNL.0000000000010998