{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:56:34Z","timestamp":1791446194545,"version":"4.3.3"},"reference-count":50,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006306","name":"Sigrid Jus\u00e9liuksen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006306","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1U01DK140923\u201001"],"award-info":[{"award-number":["1U01DK140923\u201001"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["movementdisorders.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Movement Disorders"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Gastrointestinal dysfunction is increasingly recognized as a core feature of Parkinson's disease (PD), affecting quality of life, nutrition, medication response, and potentially the earliest stages of pathogenesis. This perspective traces the evolution of the gut from a neglected source of non\u2010motor symptoms to a central component of biological models of PD. Gastrointestinal manifestations are physiologically heterogeneous and require objective phenotyping to distinguish dysphagia, gastroparesis, slow transit, defecatory dysfunction, and overlapping mechanisms. The body\u2010first\/brain\u2010first framework further suggests that Lewy pathology may follow distinct anatomical trajectories, with early enteric and autonomic involvement defining a subgroup in which gut\u2010directed biomarkers and therapies may be especially relevant. Alterations of the gut microbiome are reproducibly associated with PD, although geography, constipation, medication, diet, disease stage, and reverse causation complicate interpretation. Emerging work is shifting from taxonomy toward microbial functions and host pathways, including barrier integrity, immune and enteroendocrine signaling, short\u2010chain fatty acids, glucagon\u2010like peptide\u20101 (GLP\u20101), host genetic susceptibility, \u03b1\u2010synuclein aggregation and propagation, and microbial levodopa metabolism. Trials of probiotics, fecal microbiota transplantation, and dietary interventions remain heterogeneous and have not established disease\u2010modifying efficacy. Progress will require longitudinal studies in prodromal and subtype\u2010defined populations, objective gastrointestinal measurements, integrated microbial, host\u2010genetic and other multi\u2010omics, mechanistic human and animal models, and clinical trials combining target\u2010engagement markers with meaningful outcomes. Such an approach may enable precision gut\u2010brain medicine for appropriately selected patients with PD. \u00a9 2026 The Author(s).\n                    <jats:italic>Movement Disorders<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.\n                  <\/jats:p>","DOI":"10.1002\/mds.70566","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T07:41:31Z","timestamp":1791445291000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Gut\u2013Brain Axis in Parkinson's Disease: From Clinical Observation toward Mechanism\u2010Based Precision Medicine"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9502-7131","authenticated-orcid":false,"given":"Filip","family":"Scheperjans","sequence":"first","affiliation":[{"name":"Department of Neurology, HUS Neurocenter Helsinki 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