The effect of probiotic supplementation on constipation in patients with Parkinson’s disease: A randomized controlled trial

Saeedeh  Zareie; Maziar  Emamikhah; Mohammad  Rohani; Ahmad  Saedisomeolia

doi:10.18502/cjn.v24i3.21596

Saeedeh Zareie Ward of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
Maziar Emamikhah Department of Neurology, Hazrat Rasool Medical Complex, Iran University of Medical Sciences, Tehran, Iran
Mohammad Rohani Department of Neurology, Hazrat Rasool Medical Complex, Iran University of Medical Sciences, Tehran, Iran
Ahmad Saedisomeolia Higher Education College of Health Sciences, Education Centre of Australia, Parramatta, NSW, Australia

DOI: https://doi.org/10.18502/cjn.v24i3.21596

Keywords: Parkinson’s Disease; Constipation; Probiotics; Gut Microbiota; Randomized Controlled Trial

Abstract

Background: Constipation is a common non-motor symptom (NMS) in Parkinson’s disease (PD), affecting up to 70% of patients and reducing quality of life (QOL). Probiotics may improve bowel function via gut microbiota modulation and gut-brain axis regulation. This randomized, double-blind, placebo-controlled trial evaluated the efficacy of six-week multi-strain probiotic supplementation on constipation in Iranian patients with PD.

Methods: Seventy-two patients with PD (aged 50-80 years, functional constipation per Rome IV criteria) were randomized 1:1 to probiotics or placebo. The probiotic capsule contained Lactobacillus acidophilus (L. acidophilus), Lactobacillus casei (L. casei), Lactobacillus rhamnosus (L. rhamnosus), Bifidobacterium lactis (B. lactis), Bifidobacterium longum (B. longum), and Bifidobacterium breve (B. breve) [1 × 10⁹ colony-forming unit (CFU) each, total 12 × 10⁹ CFU/day]. Dietary intake and physical activity were assessed and included as covariates in analysis of covariance (ANCOVA) models. Primary outcome was weekly spontaneous bowel movements (SBMs); secondary outcomes included Patient Assessment of Constipation-Quality of Life (PAC-QOL) and Unified Parkinson's Disease Rating Scale (UPDRS) Part III. Baseline demographic, clinical, dietary, and physical activity characteristics were comparable between groups.

Results: The study involved patients with a mean age of 69.53 [standard deviation (SD) = 13.4] years, who were hospitalized for about 4.97 days. Gender distribution was with women at 51% and men at 49%. After discharge, a significant majority (66%) received care exclusively from private settings, while 34% utilized both private and governmental services. In contrast, governmental settings showed no significant differences in costs related to NIHSS scores (P = 0.120). Similarly, Barthel scores indicated notable cost disparities in private settings at all stages (P = 0.0001), while governmental settings exhibited no significant differences post-discharge (P = 0.777).

Conclusion: Our study reveals that patients primarily rely on private settings for post discharge services, with costs largely borne by themselves. The financial burden of hospitalization is mostly covered by basic insurance.