Role of chronic infection and inflammation in the gastrointestinal tract in the etiology and pathogenesis of idiopathic parkinsonism. Part 1: eradication of Helicobacter in the cachexia of idiopathic parkinsonism.
BACKGROUND
Neuronal damage in idiopathic parkinsonism may be in response to ubiquitous occult infection. Since peptic ulceration is prodromal, Helicobacter is a prime candidate.


OBJECTIVE
To consider the candidature of Helicobacter in parkinsonism with cachexia.


METHODS
We explore the relationship between being underweight and inflammatory products in 124 subjects with idiopathic parkinsonism and 195 controls, and present the first case-series evidence of efficacy of Helicobacter eradication, in parkinsonism advanced to the stage of cachexia.


RESULTS
Association of a low body mass index with circulating interleukin-6 was specific to parkinsonism (p = .002), unlike that with antibodies against Helicobacter vacuolating-toxin and cytotoxicity-associated gene product (p < .04). Marked reversibility in both cachexia and disability of idiopathic parkinsonism followed Helicobacter heilmannii eradication in one case, Helicobacter pylori eradication in another, follow-up being > or = 3.5 years. The latter presented with postprandial bloating, and persistent nausea: following eradication, radioisotope gastric-emptying returned towards normal, and upper abdominal symptoms regressed. Reversibility of their cachexia/disability contrasts with the outcome of anti-Helicobacter therapy where eradication repeatedly failed (one case), and in non-Helicobacter gastritis (three cases). Anti-parkinsonian medication remained constant. Intestinal absorption and barrier function were normal in all.


CONCLUSIONS
Categorization, according to presence or absence of Helicobacter infection, was a useful therapeutic tool in late idiopathic parkinsonism.
Dobbs
R John
RJ
Section of Clinical Neuropharmacology, Institute of Psychiatry, London, UK. dobbs@wellers.demon.co.uk
Dobbs
Sylvia M
SM
Weller
Clive
C
Bjarnason
Ingvar T
IT
Bjarnason
Ingua T
IT
Oxlade
Norman L
NL
Charlett
André
A
Al-Janabi
Mazin A
MA
Kerwin
Robert W
RW
Mahler
Robert F
RF
Price
Ashley B
AB
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002100:Cachexia / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology* / Q000503:physiopathology; D002908:Chronic Disease; D005260:Female; D016481:Helicobacter Infections / Q000150:complications* / Q000188:drug therapy* / Q000276:immunology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000209:etiology* / Q000382:microbiology* / Q000503:physiopathology; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents