title: Motor fluctuations and Helicobacter pylori in Parkinson's disease.
abstract: The presence of Helicobacter pylori (HP) in the gastrointestinal tract may limit the absorption of levodopa. The objectives of this study were to investigate whether HP infection may affect the clinical response to levodopa as well as levodopa dose requirement in patients with Parkinson's disease (PD) as well as to investigate whether HP infection may affect plasma levels of vitamin B12, folic acid, and homocysteine. Seventy-five patients with PD diagnosed at least 4 years ago were included. Symptom fluctuations were assessed by UPDRS-IV and the WOQ9 wearing-off-scale. Plasma levels of vitamin B12, folic acid, and homocysteine were analyzed. Screening for HP was performed with a 13C-labeled urea breath test (Diabact UBT). A propensity-matched analysis was made where each patient in the HP-infected group was matched with one patient in the non-infected group with respect to age and gender. Of the 75 included patients, 20 were HP infected (27 %). Median Hoehn & Yahr scores were 3 in both HP infected patients and the matched group (n = 20). HP-infected patients had decreased "complications of therapy" with average total UPDRS-IV score of 4.8 ± 3.0 vs. 7.7 ± 3.8 (p < 0.05), despite no significant difference in levodopa equivalent dose. Wearing-off and sleep disturbance were significantly less common in the HP group (p < 0.05). There were no differences regarding vitamin B12, folic acid, or homocysteine values. HP infection in patients with PD may result in a decreased occurrence of symptom fluctuations according to this small study. This finding may be due to altered absorption of levodopa in the gastrointestinal tract in patients with HP infection, but further studies are required.
authors.affiliation: NeuroCenter Saint Göran Hospital, Stockholm, Sweden.
authors.forename: Karl-Erik
authors.initials: KE
authors.lastname: Rahne
authors.forename: Carl
authors.initials: C
authors.lastname: Tagesson
authors.forename: Dag
authors.initials: D
authors.lastname: Nyholm
mesh_terms: D000368:Aged; D000978:Antiparkinson Agents / Q000378:metabolism* / Q000627:therapeutic use; D001944:Breath Tests; D005260:Female; D005492:Folic Acid / Q000097:blood; D016481:Helicobacter Infections / Q000150:complications* / Q000378:metabolism; D016480:Helicobacter pylori; D006801:Humans; D007408:Intestinal Absorption; D007980:Levodopa / Q000378:metabolism* / Q000627:therapeutic use; D008297:Male; D010300:Parkinson Disease / Q000188:drug therapy / Q000378:metabolism / Q000382:microbiology*; D016896:Treatment Outcome; D014805:Vitamin B 12 / Q000097:blood
chemical_list: D000978:Antiparkinson Agents; D007980:Levodopa; D005492:Folic Acid; D014805:Vitamin B 12