Helicobacter pylori eradication and l-dopa absorption in patients with PD and motor fluctuations.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Pierantozzi
M
M
IRCCS Santa Lucia Foundation, Department of Neuroscience, Tor Vergata University, and S. Raffaele Hospital, Rome, Italy.
Pietroiusti
A
A
Brusa
L
L
Galati
S
S
Stefani
A
A
Lunardi
G
G
Fedele
E
E
Sancesario
G
G
Bernardi
G
G
Bergamaschi
A
A
Magrini
A
A
Stanzione
P
P
Galante
A
A
D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007980:Levodopa / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology / Q000378:metabolism* / Q000517:prevention & control*; D010300:Parkinson Disease / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism*; D015990:Placebo Effect; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D007980:Levodopa