Helicobacter pylori infection and motor fluctuations in patients with Parkinson's disease
ABSTRACT To investigate whether Helicobacter pylori (HP) infection affects the clinical response to levodopa and whether its eradication could improve motor fluctuation in patients with Parkinson's disease (PD). Using the [(13)C] urea breath test, we monitored HP infection in 65 patients with PD and motor fluctuations of the "wearing-off" or delayed "on" types, with or without dyskinesia. We compared the clinical features and response to L-dopa between HP noninfected (n = 30) and HP infected patients (n = 35) by reviewing home diaries kept for 72 hours. Among HP infected patients, we compared the differences in L-dopa "onset" time, "on-time" duration, and scores on the motor examination section of the Unified PD Rating Scale (UPDRS-III) during the medication "on" phase before and after HP eradication. There were no differences in the age, disease duration, Hoehn and Yahr stage, UPDRS-III score, L-dopa daily dose, and frequency of dyskinesia between HP noninfected and HP infected groups. However, L-dopa "onset" time was longer and "on-time" duration was shorter in HP infected patients than in HP noninfected patients (78.4 +/- 28.2 vs. 56.7 +/- 25.1 and 210.0 +/- 75.7 vs. 257.7 +/- 68.9 min, respectively, P < 0.05). HP eradication improved the delay L-dopa "onset" time and short "on-time" duration (to 58.1 +/- 25.6 and to 234.4 +/- 66.5 min, respectively, P < 0.05). These data demonstrated that HP infection could interfere with the absorption of L-dopa and provoke motor fluctuations. HP eradication can improve the motor fluctuations of HP infected patients with PD.
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ABSTRACT: Helicobacter pylori is a Gram-negative bacterium that infects the stomach of more than half of the world's population. H. pylori infection is an established risk factor for gastric cancer, although it is not sufficient cause for the appearance of cancer, per se. Several studies have investigated the role of this bacterium in non-cancer diseases, including gastritis ulcer, duodenal ulcer, gastroesophageal reflux, cardiovascular diseases, neurodegenerative diseases, ocular diseases, and dermatological disorders. DNA damage and failure in antioxidant defences is a common denominator of many among these pathological conditions. The clinical outcome of H. pylori infection is dependent on many variables, including H. pylori genotype, host health status, host genotype, and host exposure to environmental factors. The role of genetic and environmental factors is reviewed in this paper. Among non-cancer diseases, idiopathic thrombocytopenic purpura appears to show the strongest link with H. pylori. There is an evidence for a role of CagA-positive H. pylori infection in atherosclerosis and ischemic heart disease. On the whole, the major factors playing a pathogenic role in H. pylori-related non-cancer diseases are: (a) host polymorphisms in genes involved in inflammation and protection against oxidative damage, (b) host exposure to dietary genotoxic agents, and (c) bacterial genetic polymorphisms. In conclusion, there is an evidence that mutagenesis-related mechanisms play a pathogenic role in the appearance of non-cancer diseases following H. pylori infection.Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis 08/2009; 667(1-2):142-57. DOI:10.1016/j.mrfmmm.2009.02.002 · 4.44 Impact Factor
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ABSTRACT: For two decades, Helicobacter pylori has been considered as the culprit in many extragastric manifestations. However, for several of these supposed associations the hypothesis of an etiological role has not yet been fully investigated. This may be due to a series of factors linked to the epidemiological features of the studies and to the diseases investigated. This review attempts to highlight the main reported associations of H. pylori with extragastric manifestations during the last year. The most convincing data arise in the field of idiopathic thrombocytopenic purpura (ITP) and sideropenic anemia. Long-term follow-up studies have shown that 50% of subjects with ITP maintain a hematological response after H. pylori eradication. There is also growing evidence of the role of H. pylori in other diseases, including ischemic heart disease even though results are not conclusive.Helicobacter 10/2009; 14 Suppl 1(1):58-68. DOI:10.1111/j.1523-5378.2009.00699.x · 2.99 Impact Factor
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ABSTRACT: Levodopa is the mainstay of treatment for alleviating the motor symptoms associated with Parkinson's disease. However, patients often experience fluctuations in their symptoms over time and 'wearing off' which may be partly related to variable absorption of the drug. There is some evidence that treatment of the common gastrointestinal infection Helicobacter pylori (H pylori) with antibiotics may improve levodopa absorption in the gut and hence improve symptoms. 1) What is the prevalence of H pylori in Parkinson's disease patients? 2) Does treatment of H pylori infection with antibiotics improve symptoms in Parkinson's disease patients? Is this effect dependent on improvements in the absorption of levodopa? We searched electronic databases (including CENTRAL, MEDLINE, EMBASE, PsycINFO and CINAHL) and trial registers, handsearched conference proceedings and carried out citation searching on key articles. All searching was updated in August 2009. We contacted authors to provide additional information where necessary. Clinical trials in patients with a well-defined definition of Parkinson's disease and who were H pylori-positive. Two people independently selected studies for inclusion using predetermined criteria. We used recruitment figures from clinical trials and other studies identified from the searching to determine the prevalence of H pylori in Parkinson's disease. Two authors abstracted data from the source papers and assessed methodological quality independently. We presented results descriptively. Two completed and one ongoing clinical trial met the inclusion criteria. One trial (34 patients randomised) examined the effects of H pylori eradication on levodopa absorption and motor symptoms and found significant improvements in both. The ongoing trial has similar objectives and aims to recruit 100 patients. The other completed trial (20 patients analysed) sought to find a causal link between infection with H pylori and Parkinsonism and was non-contributory. A worsening of symptoms was noted with eradication failure.The prevalence of H pylori in Parkinson's disease was reported in four studies and ranged from 37% to 59% which is similar to that of the general population. There is currently a lack of evidence on the effects of screening and treating H pylori in patients with Parkinson's disease. There is limited evidence to suggest that H Pylori eradication improves the absorption of levodopa and improves motor symptoms. Results from an ongoing trial will inform the evidence base and will be incorporated in an update of this review. There is a need for well-conducted randomised controlled trials with standard outcome measures for motor symptoms and incorporating the costs of screening and treatment.Cochrane database of systematic reviews (Online) 11/2011; DOI:10.1002/14651858.CD008453.pub2 · 5.94 Impact Factor