Eradication of Helicobacter pylori Infection Improves Levodopa Action, Clinical Symptoms and Quality of Life in Patients with Parkinson's Disease

Abstract

BackgroundPrevious studies have demonstrated a higher prevalence of Helicobacter pylori (H. pylori) infection in patients with Parkinson's disease (PD) compared to controls. H. pylori infection affects levodopa absorption and its eradication significantly improves clinical response to levodopa. Here, we studied the prevalence of H. pylori infection and its eradication effects among our PD patients.MethodsA prospective study involving idiopathic PD patients on levodopa therapy. 13C-urea breath test (UBT) was used to detect H. pylori. UBT-positive patients were given standard eradication therapy and followed up at 6 and 12 weeks in an open label single arm design. Repeat UBT was performed at 12 weeks. The UPDRS, PD NMQ, PD NMSS and PDQ-39 were administered at baseline and post-eradication (6 and 12 weeks). Levodopa ‘onset’ time and ON-duration were recorded.ResultsOf 82 patients recruited, 27 (32.9%) had positive UBT. H. pylori-positive patients had significantly poorer total UPDRS (p = 0.005) and PDQ39 (p<0.0001) scores compared to H. pylori-negative patients. At 12 weeks post-eradication, the mean levodopa onset time shortened by 14 minutes (p = 0.011). The mean ON duration time increased by 56 minutes at week 6 (p = 0.041) and 38 minutes at week 12 (p = 0.035). The total UPDRS scores (p<0.0001), scores for parts II (p = 0.001), III (p<0.0001) and IV (p = 0.009) were significantly better. The total PDQ-39 scores (p = 0.001) and subdomains mobility (p = 0.002), ADL (p = 0.001), emotional well being (p = 0.026) and stigma (p = 0.034) significantly improved. The PD NMSQ did not show significant improvement.Conclusions H. pylori eradication improved levodopa onset time, ON duration, motor severity and quality of life parameters. Screening and eradication of H. pylori is inexpensive and should be recommended in PD patients, particularly those with erratic response to levodopa.Trial RegistrationClinicalTrials.gov NCT02112812

Association ofHelicobacter pyloriwith Parkinson's Disease

“…These findings are consistent with those of other studies 1623. It has been demonstrated that H. pylori -related gastritis reduces gastric acid secretion by releasing the proinflammatory cytokine interleukin-1b 23.…”

Recent developments in understanding the role of the gut microbiota in brain health and disease

“…H. pylori infection may contribute to the development of parkinsonian symptoms through degenerating dopaminergic neurons in the brain . Interestingly, eradication of H. pylori has been shown to enhance the onset time of levodopa (first‐line pharmacological treatment for Parkinson's disease symptoms) while also improving tremor, rigidity, and walking ability . Metagenomic analysis has revealed that genes involved in the biosynthesis of LPS are upregulated in parkinsonian patients, suggesting that a dysregulated microbiota is potentially driving aberrant immune activation in the neurodegenerative disease …”

Clinical background factors affecting outcomes of Helicobacter pylori eradication therapy in primary care

“…Helicobacter pylori eradication therapy can be beneficial in patients with other specific diseases, such as idiopathic thrombocytopenic purpura, mucosa‐associated lymphoid tissue lymphoma, and iron‐deficiency anemia . Recent studies have also addressed the association between H pylori infection and type 2 diabetes mellitus, Parkinson's disease, and coronary artery disease . For these reasons, eradication therapy should be recommended/enforced for all patients with H pylori infection, for the purpose of preventive medicine.…”