Vagotomy and subsequent risk of Parkinson's disease

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OBJECTIVES: Parkinson's disease (PD) may be caused by an enteric neurotropic pathogen entering the brain through the vagal nerve, a process that may take over 20 years. We investigated the risk of PD in patients who underwent vagotomy, and hypothesized that truncal vagotomy is associated with a protective effect, while super-selective vagotomy has a minor effect.

METHODS: We constructed cohorts of all patients in Denmark who underwent vagotomy during 1977-1995 and a matched general population cohort, by linking Danish registries. We used Cox regression to compute hazard ratios (HRs) for PD and corresponding 95% confidence intervals [CIs], adjusting for potential confounders.

RESULTS: Risk of PD was decreased in patients who underwent truncal [HR = 0.85, 95% CI= 0.56-1.27; follow-up of >20 years: HR = 0.58, 95% CI: 0.28-1.20] compared to super-selective vagotomy. Risk of PD was also decreased following truncal vagotomy when compared to the general population cohort [overall adjusted HR = 0.85, 95% CI 0.63-1.14; follow-up >20 years, adjusted HR = 0.53 [95% CI: 0.28-0.99]. In patients who underwent super-selective vagotomy, risk of PD was similar to the general population [HR = 1.09, 95% CI: 0.84-1.43; follow-up of >20 years: HR = 1.16, 95% CI: 0.80-1.70]. The statistical precision of the risk estimates was limited. Results were consistent after external adjustment for unmeasured confounding by smoking.

INTERPRETATION: Full truncal vagotomy is associated with a decreased risk for subsequent PD, suggesting that the vagal nerve may be critically involved in the pathogenesis of PD. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalAnnals of Neurology
Volume78
Issue4
Pages (from-to)522–529
ISSN0364-5134
DOIs
Publication statusPublished - 29 May 2015

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