Michael S. Okun, MD reviewing Liu B et al. Neurology 2017 Apr 26.

Clinicians should be aware of a changing landscape in Parkinson disease that may, in the future, focus more on the gut.

Truncal vagotomy is a surgical procedure that functionally denervates and disconnects multiple organs, including the stomach, liver, gallbladder, pancreas, small intestine, and proximal colon. Selective vagotomy disconnects only the stomach. Swedish investigators used a national registry to attempt to determine whether vagotomy reduces later risk for developing Parkinson disease (PD). Using a matched-cohort study design, these authors compared 9430 patients who had previously undergone vagotomy (3445 truncal, 5978 selective, 7 unknown type) with a control group matched for sex and birth year. One advantage of the registry was that the authors followed patients from the time of the surgical procedure until PD was identified, the patient died, or the patient left Sweden.

There were 4930 cases of incident PD. The incidence rate was 61.8 in vagotomized patients and 67.5 in the control group. The truncal vagotomy group had a higher incidence than the selective vagotomy group (80.4 vs. 55.1). Overall, surgical vagotomy was not associated with PD risk, although the authors point out a “suggestion of lower risk” in the truncal group (hazard ratio, 0.78; 95% confidence interval, 0.55–1.09).

CITATION(S):

Liu B et al. Vagotomy and Parkinson disease: A Swedish register–based matched-cohort study. Neurology 2017 Apr 26; [e-pub].

JWatch