Helicobacter pylori eradication and L-dopa absorption in patients with PD and motor fluctuations - Reply
University of Rome Tor Vergata, Roma, Latium, Italy Neurology
(Impact Factor: 8.29).
07/2006; 66(12):1824-9. DOI: 10.1212/01.wnl.0000221672.01272.ba
To investigate if Helicobacter pylori (HP) eradication could make an effective and long-lasting improvement in the pharmacokinetic and clinical response to l-dopa in patients with Parkinson disease (PD) and motor fluctuations.
In a group of 34 HP-infected, motor-fluctuating patients with PD, the short-term (1-week) and long-term (3-month) beneficial effect of HP eradication (n = 17) was investigated in a double-blind fashion in comparison with a generic antioxidant treatment (n = 17), by means of pharmacokinetic, clinical, and gastrointestinal assessments. Results were compared with placebo treatment.
Differently from the antioxidant-treated patients, the HP-eradicated patients showed a significant increase of l-dopa absorption, which was coupled with a significant improvement of clinical disability and with a prolonged "on-time" duration, whereas gastritis/duodenitis scores significantly decreased in line with a better l-dopa pharmacokinetics.
These data demonstrate a reversible Helicobacter pylori (HP)-induced interference with l-dopa clinical response related to the impaired drug absorption, probably due to active gastroduodenitis. Therefore, the authors suggest that HP eradication may improve the clinical status of infected patients with Parkinson disease and motor fluctuations by modifying l-dopa pharmacokinetics.
Available from: Ilona Csoti
- "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.
Available from: Hany Shabana
- "This information indicates that HP infection may modify LD uptake and responsible for MF in patients with PD. These are in agreement with Pierantozzi et al. (2006) who stated that HP prompted intervention with LD clinical reaction due to the altered drug uptake, presumably related to active gastroduodenitis 26 . "
Available from: PubMed Central
- "Gastrointestinal dysfunction, with erratic gastric emptying worsening over the years, is a common cause of poor absorption of L-Dopa in PD. There is no gastric absorption of L-Dopa, indeed; so gastric emptying and transit via the pyloric sphincter are critical factors for regular intestinal absorption . "
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ABSTRACT: Patients at late stage Parkinson's disease (PD) develop several motor and nonmotor complications, which dramatically impair their quality of life. These complications include motor fluctuations, dyskinesia, unpredictable or absent response to medications, falls, dysautonomia, dementia, hallucinations, sleep disorders, depression, and psychosis. The therapeutic management should be driven by the attempt to create a balance between benefit and side effects of the pharmacological treatments available. Supportive care, including physical and rehabilitative interventions, speech therapy, occupational therapy, and nursing care, has a key role in the late stage of disease.
In this review we discuss the several complications experienced by advance PD patients and their management. The importance of an integrative approach, including both pharmacological and supportive interventions, is emphasized.
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