Vagotomy and subsequent risk of Parkinson's disease.
Level 3 - non-randomized controlled study
Nationwide matched retrospective cohort study
PubMed 26031848 · doi:10.1002/ana.24448
What was done
Using Danish nationwide health registries, researchers identified all patients who underwent vagotomy (truncal or superselective) between 1977 and 1995 and constructed a matched general population comparison cohort. Cox regression was used to calculate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for developing Parkinson's disease (PD), analyzing overall follow-up and follow-up exceeding 20 years, with external adjustment for unmeasured smoking confounding.
What was found
Truncal vagotomy was associated with a reduced risk of PD compared to superselective vagotomy overall (HR = 0.85; 95% CI = 0.56-1.27) and after >20 years of follow-up (HR = 0.58; 95% CI: 0.28-1.20). Compared to the matched general population cohort, truncal vagotomy had an overall adjusted HR of 0.85 (95% CI: 0.63-1.14) and a statistically significant reduction after >20 years (adjusted HR = 0.53; 95% CI: 0.28-0.99). Superselective vagotomy showed PD risk similar to the general population overall (HR = 1.09; 95% CI: 0.84-1.43) and at >20 years (HR = 1.16; 95% CI: 0.80-1.70). The authors noted that statistical precision was limited.
Why it matters
This study provides population-level epidemiological support for the hypothesis that Parkinson's disease pathogenesis may involve retrograde spread of a pathogen or pathology from the gut via the vagus nerve.
Limits
The abstract does not state the total sample size or number of PD cases. Statistical precision was limited (wide confidence intervals), and unmeasured residual confounding related to the underlying indication for surgery cannot be fully ruled out.
Cited by
- partial Individuals who have undergone a vagotomy have a significant reduction in the risk of developing Parkinson's disease.