The Effect of Proximal Colonic Irrigation (King’s 3-2-1 Bowel Cleansing Regime) on Motor and Nonmotor Symptoms in Parkinson’s Disease: A Cross Racial Retrospective Review

Parkinson’s disease (PD) is associated with widespread gastrointestinal (GI) dysfunction including gut microbiota dysbiosis affecting the entire gastrointestinal tract with fecal impaction and constipation being a common symptom. We initiated a pathway of proximal colonic irrigation with standard colonoscopy and targeted irrigation followed by bowel preparation with polyethylene glycol 3350 in a 3-2-1 bowel cleansing pattern to help levodopa absorption and consequent motor and nonmotor symptoms (NMS) in a cross racial cohort of PD patients with fecal impaction (Leech score) and constipation since 2022. The pathway has been used in PD patients referred for dopamine replacement therapy (DRT) optimisation with refractory motor fluctuations as well as GI symptoms (constipation, bloating, abdominal discomfort). Patients undergo proximal colonic irrigation and subsequent 3-2-1 bowel cleansing regime with assessment of motor and nonmotor scores (baseline, 3 and 6 months). Review of outcome measures shows significant improvements in constipation and NMS burden and Leech scores at 3 months persisting at 6 months follow-up. In addition, Unified Parkinson's Disease Rating Scale (UPDRS) Part III and Part IV scores, wearing-off symptoms, and Levodopa Equivalent Daily Dose (LEDD) decreased significantly across all racial groups. Controlled prospective studies are required to validate proximal colonic irrigation followed by the 3-2-1 bowel cleansing strategy in PD cases with poor response to DRT, fecal loading and constipation.