Vagotomy and Parkinson disease: A Swedish register-based matched-cohort study.
Level 3 - non-randomized controlled study
Nationwide non-randomized matched cohort study
PubMed 28446653 · doi:10.1212/WNL.0000000000003961
What was done
Nationwide Swedish register-based matched-cohort study of 9,430 vagotomized patients (3,445 truncal, 5,978 selective) identified between 1970 and 2010 and 377,200 general population reference individuals matched 40:1 by sex and birth year. Participants were followed up until Parkinson disease (PD) diagnosis, death, emigration, or December 31, 2010. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox models adjusted for country of birth, chronic obstructive pulmonary disease, diabetes, vascular diseases, rheumatologic disease, osteoarthritis, and comorbidity index.
What was found
Over 7.3 million person-years of follow-up, 4,930 incident PD cases were identified. Incidence of PD per 100,000 person-years was 61.8 in vagotomized patients (80.4 truncal, 55.1 selective) and 67.5 in reference individuals. Overall vagotomy was not associated with PD risk (HR 0.96, 95% CI 0.78-1.17). Truncal vagotomy showed a trend toward reduced risk (HR 0.78, 95% CI 0.55-1.09), driven by procedures performed at least 5 years prior to PD diagnosis (HR 0.59, 95% CI 0.37-0.93). Selective vagotomy was not associated with PD risk.
Why it matters
These findings support the hypothesis that Parkinson disease pathology may originate in the gastrointestinal tract and ascend to the central nervous system via the vagus nerve.
Limits
Observational study design relying on administrative registers, potential confounding by unmeasured factors such as smoking, and possible misclassification of vagotomy type or diagnostic timing.
Cited by
- partial Individuals who have undergone a vagotomy have a significant reduction in the risk of developing Parkinson's disease.