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Helicobacter pylori (H. pylori) infection can induce motor fluctuations by interrupting the absorption of levodopa in PD patients [26-29]. Eradication of H.

Symptoms of autonomic dysfunction can impact more on quality of life than motor symptoms. Appropriate symptom-oriented diagnosis and symptomatic treatment as part of an interdisciplinary approach can greatly benefit the patient.

This review elaborates a limited overview on the treatment of cardiovascular, gastrointestinal, urogenital and sudomotor autonomic dysfunction in various extrapyramidal syndromes. .

In PD patients, disease duration and severity, quality of life, and nonmotor symptoms were also examined and then the clinical features of GERD were analyzed. A total of 102 patients and 49 controls were enrolled and 21 patients and 4 controls had heartburn, significantly frequent in PD. The prevalence rate of GERD was 26.5% in PD and the odds ratio was 4.05. Heartburn, bent forward flexion, and wearing-off phenomenon were frequent, and scores of UPDRS, total and part II, PD questionnaire-39, and nonmotor symptom scale were significantly higher in PD patients with GERD than without GERD. Multiple logistic regression analysis revealed statistical significance in UPDRS part II and nonmotor symptom scale.

Although Lewy bodies in the alimentary system have been reported in autopsy cases with megacolon and achalasia [13-15], there is no direct evidence of the association between GERD and the lower esophageal Lewy bodies. However, these previous reports reasonably support that pathological abnormality of the lower esophagus may cause the clinical symptoms of GERD in PD.

Increased attention should be given to detect GERD in PD. Gastrointestinal dysfunction is one of the most common nonmotor features of Parkinson’s disease (PD), from the original description by James Parkinson. Variable abnormalities from the mouth through the rectum are already known [2].

Anna Marie Riechmann (born Bredemeier), born Circa 1725

Dysphagia is relatively common and observed in 29%-80% of PD patients [2, 3], which can be induced by dyscoordination of various organs such as the mouth, pharynx, and esophagus. In addition to abnormalities of esophageal peristalsis, dysfunction in the lower esophageal sphincter can also produce clinical symptoms of gastroesophageal reflux [4-6]. Treatment of esophageal problems in PD still remains difficult. However, symptoms derived from gastroesophageal reflux can be treated with appropriate antireflux measures.

This study suggests that GERD is prevalent in PD. Deterioration of daily living activities and other nonmotor symptoms can imply the presence of GERD. Because clinical symptoms of GERD are usually treatable, the management can improve the patient’s quality of life.

Unlike NVP, symptoms may persist well into the second or third trimesters due to the enlarging uterus and displacement of the intra-abdominal organs and lower esophageal sphincter. Comanagement of NVP and reflux is often necessary in order to maximize treatment benefit. The aim of this chapter is to present the clinical presentation; diagnosis and management strategies of NVP, HG, and reflux; and the more infrequent occurrence of ptyalism in pregnancy. Although extrapyramidal diseases are commonly thought to solely affect the (extrapyramidal) motor system, non-motor symptoms such as behavioural abnormalities, dysautonomia, sleep disturbances and sensory dysfunctions are also frequently observed. Autonomic dysfunction is an important clinical component of extrapyramidal disease, but it is often not formally assessed, and thus frequently misdiagnosed.

Gastroesophageal reflux symptoms characterized by heartburn and regurgitation are generally recognized as clinical symptoms of gastroesophageal reflex disease (GERD). GERD can also show dyspeptic manifestations other than reflux symptoms.

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