title: The role of small intestinal bacterial overgrowth in Parkinson's disease.
abstract: Parkinson's disease is associated with gastrointestinal motility abnormalities favoring the occurrence of local infections. The aim of this study was to investigate whether small intestinal bacterial overgrowth contributes to the pathophysiology of motor fluctuations. Thirty-three patients and 30 controls underwent glucose, lactulose, and urea breath tests to detect small intestinal bacterial overgrowth and Helicobacter pylori infection. Patients also underwent ultrasonography to evaluate gastric emptying. The clinical status and plasma concentration of levodopa were assessed after an acute drug challenge with a standard dose of levodopa, and motor complications were assessed by Unified Parkinson's Disease Rating Scale-IV and by 1-week diaries of motor conditions. Patients with small intestinal bacterial overgrowth were treated with rifaximin and were clinically and instrumentally reevaluated 1 and 6 months later. The prevalence of small intestinal bacterial overgrowth was significantly higher in patients than in controls (54.5% vs. 20.0%; P = .01), whereas the prevalence of Helicobacter pylori infection was not (33.3% vs. 26.7%). Compared with patients without any infection, the prevalence of unpredictable fluctuations was significantly higher in patients with both infections (8.3% vs. 87.5%; P = .008). Gastric half-emptying time was significantly longer in patients than in healthy controls but did not differ in patients based on their infective status. Compared with patients without isolated small intestinal bacterial overgrowth, patients with isolated small intestinal bacterial overgrowth had longer off time daily and more episodes of delayed-on and no-on. The eradication of small intestinal bacterial overgrowth resulted in improvement in motor fluctuations without affecting the pharmacokinetics of levodopa. The relapse rate of small intestinal bacterial overgrowth at 6 months was 43%. © 2013 Movement Disorder Society.
authors.affiliation: Department of Neurology, Catholic University of Sacred Heart, Gemelli University Hospital, Rome, Italy. alfonso.fasano@gmail.com
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fasano
authors.forename: Francesco
authors.initials: F
authors.lastname: Bove
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gabrielli
authors.forename: Martina
authors.initials: M
authors.lastname: Petracca
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Zocco
authors.forename: Enzo
authors.initials: E
authors.lastname: Ragazzoni
authors.forename: Federico
authors.initials: F
authors.lastname: Barbaro
authors.forename: Carla
authors.initials: C
authors.lastname: Piano
authors.forename: Serena
authors.initials: S
authors.lastname: Fortuna
authors.forename: Annalisa
authors.initials: A
authors.lastname: Tortora
authors.forename: Raffaella
authors.initials: R
authors.lastname: Di Giacopo
authors.forename: Mariachiara
authors.initials: M
authors.lastname: Campanale
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gigante
authors.forename: Ernesto Cristiano
authors.initials: EC
authors.lastname: Lauritano
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Navarra
authors.forename: Stefano
authors.initials: S
authors.lastname: Marconi
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Bentivoglio
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001944:Breath Tests; D060740:Disease Eradication; D004751:Enteritis / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D005260:Female; D005746:Gastric Emptying; D005769:Gastrointestinal Motility / Q000502:physiology; D005947:Glucose / Q000378:metabolism; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control; D001616:beta-Galactosidase / Q000378:metabolism
chemical_list: D001616:beta-Galactosidase; D005947:Glucose
keywords: Helicobacter pylori; Parkinson's disease; motor fluctuations; small intestinal bacterial overgrowth