Introduction: The gut-first hypothesis of Parkinsons Disease (PD) has gained traction, yet the inciting events triggering PD from gut-related factors remain unclear. While H. pylori infection is linked to peptic injury and is 1.47 times more prevalent in PD individuals, it is unknown how gastrointestinal mucosal damage (MD) may increase the risk of PD. We aimed to study the association between upper endoscopy findings of MD and subsequent PD development. Methods: In our retrospective study of 18,305 adults without prior PD, undergoing upper endoscopy between 2000 and 2005, patients with MD were matched with non-MDs. PD risk in MDs versus non-MDs was assessed using incidence rate ratio (IRR) and multivariate Cox analysis, controlling for covariates. Results: In the matched cohort, MD patients were significantly more likely to develop PD (IRR 3.00, p<0.0001), even after covariate adjustment (HR 2.42, p<0.001). Covariates including constipation, dysphagia, older age, and male sex were also associated with higher PD risk. Among MDs, H. pylori presence (AOR 5.38, p=0.04) and chronic NSAID use (AOR 3.28, p=0.04) increased PD odds, while chronic smoking decreased PD odds (AOR 0.19, p<0.05). Conclusion: MD elevates PD risk, with H. pylori increasing risk only in the presence of MD, suggesting a closer link between PD and gastric mucosa disruption. Furthermore, chronic NSAID use significantly raises PD odds in MD, while chronic smoking reduces PD risk in this context. Increased vigilance among MD patients for future PD risk is warranted, with further studies needed to elucidate precise pathophysiology.

中文翻译：

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胃肠粘膜损伤和随后患帕金森病的风险

简介：帕金森病 (PD) 的肠道优先假说已获得关注，但肠道相关因素引发帕金森病的诱发事件仍不清楚。虽然幽门螺杆菌感染与消化道损伤有关，并且在帕金森病个体中的感染率是帕金森病个体的 1.47 倍，但胃肠道粘膜损伤 (MD) 如何增加帕金森病的风险尚不清楚。我们的目的是研究 MD 上消化道内镜检查结果与随后 PD 发展之间的关联。方法：我们对 2000 年至 2005 年间接受上消化道内窥镜检查的 18,305 名既往无 PD 的成年人进行回顾性研究，将 MD 患者与非 MD 患者进行匹配。使用发病率比 (IRR) 和多变量 Cox 分析（控制协变量）评估 MD 与非 MD 的 PD 风险。结果：在匹配的队列中，MD 患者患 PD 的可能性明显更高（IRR 3.00，p<0.0001），即使在协变量调整后（HR 2.42，p<0.001）也是如此。便秘、吞咽困难、年龄较大和男性等协变量也与较高的 PD 风险相关。在MD中，幽门螺杆菌的存在（AOR 5.38，p = 0.04）和长期使用NSAID（AOR 3.28，p = 0.04）增加PD几率，而长期吸烟降低PD几率（AOR 0.19，p <0.05）。结论：MD 会增加 PD 风险，只有在存在 MD 的情况下，幽门螺杆菌才会增加风险，这表明 PD 与胃粘膜破坏之间存在更密切的联系。此外，长期使用非甾体抗炎药会显着增加 MD 的 PD 几率，而长期吸烟会降低 MD 的 PD 风险。MD 患者需要提高对未来 PD 风险的警惕性，并需要进一步研究来阐明精确的病理生理学。