Helicobacter pylori infection and motor fluctuations in patients with Parkinson's disease

Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Movement Disorders (Impact Factor: 5.68). 09/2008; 23(12):1696-700. DOI: 10.1002/mds.22190
Source: PubMed


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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    • "In several case–control studies, a negative influence has been reported for HP infection of the stomach lining on the absorption of levodopa and subsequent motor behavior in patients with PD (Tan et al. 2014b). According to some authors (Pierantozzi et al. 2006; Lee et al. 2008), eradication improves the effect of the levodopa and leads to a reduction in the rate of fluctuations. A review article from the Cochrane Collaboration , however, found but few indications for an improvement in motor behavior, so that screening of PD patients for HP cannot be recommended at present (Rees et al. 2011b). "
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    ABSTRACT: General medical problems and complications have a major impact on the quality of life in all stages of Parkinson's disease. To introduce an effective treatment, a comprehensive analysis of the various clinical symptoms must be undertaken. One must distinguish between (1) diseases which arise independently of Parkinson's disease, and (2) diseases which are a direct or indirect consequence of Parkinson's disease. Medical comorbidity may induce additional limitations to physical strength and coping strategies, and may thus restrict the efficacy of the physical therapy which is essential for treating hypokinetic-rigid symptoms. In selecting the appropriate medication for the treatment of any additional medical symptoms, which may arise, its limitations, contraindications and interactions with dopaminergic substances have to be taken into consideration. General medical symptoms and organ manifestations may also arise as a direct consequence of the autonomic dysfunction associated with Parkinson's disease. As the disease progresses, additional non-parkinsonian symptoms can be of concern. Furthermore, the side effects of Parkinson medications may necessitate the involvement of other medical specialists. In this review, we will discuss the various general medical aspects of Parkinson's disease.
    Journal of Neural Transmission 08/2015; DOI:10.1007/s00702-015-1443-z · 2.40 Impact Factor
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    • "Helicobacter pylori (H. pylori) infection can induce motor fluctuations by interrupting the absorption of levodopa in PD patients [26–29]. Eradication of H. pylori can improve these annoying problems in H. pylori-infected PD patients. "
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    ABSTRACT: The aim of this study is to investigate the frequency and clinical features of gastroesophageal reflex disease (GERD) in Parkinson's disease (PD). Consecutively recruited PD patients and controls were questioned about heartburn and GERD with a questionnaire. In PD patients, disease duration and severity, quality of life, and nonmotor symptoms were also examined and then the clinical features of GERD were analyzed. A total of 102 patients and 49 controls were enrolled and 21 patients and 4 controls had heartburn, significantly frequent in PD. The prevalence rate of GERD was 26.5% in PD and the odds ratio was 4.05. Heartburn, bent forward flexion, and wearing-off phenomenon were frequent, and scores of UPDRS, total and part II, PD questionnaire-39, and nonmotor symptom scale were significantly higher in PD patients with GERD than without GERD. Multiple logistic regression analysis revealed statistical significance in UPDRS part II and nonmotor symptom scale. This study suggests that GERD is prevalent in PD. Deterioration of daily living activities and other nonmotor symptoms can imply the presence of GERD. Because clinical symptoms of GERD are usually treatable, the management can improve the patient's quality of life. Increased attention should be given to detect GERD in PD.
    Parkinson's Disease 02/2013; 2013(3):742128. DOI:10.1155/2013/742128 · 2.01 Impact Factor
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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 · 3.68 Impact Factor
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