Vagotomy and subsequent risk of Parkinson's disease

Objective 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, whereas superselective 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 superselective vagotomy. Risk of PD was also decreased after 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 superselective 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). Statistical precision of 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. Ann Neurol 2015;78:522–529