title: Eradication of Helicobacter pylori infection improves levodopa action, clinical symptoms and quality of life in patients with Parkinson's disease.
abstract: BACKGROUND
  Previous studies have demonstrated a higher prevalence of Helicobacter pylori (H. pylori) infection in patients with Parkinson's disease (PD) compared to controls. H. pylori infection affects levodopa absorption and its eradication significantly improves clinical response to levodopa. Here, we studied the prevalence of H. pylori infection and its eradication effects among our PD patients.
  
  
  METHODS
  A prospective study involving idiopathic PD patients on levodopa therapy. 13C-urea breath test (UBT) was used to detect H. pylori. UBT-positive patients were given standard eradication therapy and followed up at 6 and 12 weeks in an open label single arm design. Repeat UBT was performed at 12 weeks. The UPDRS, PD NMQ, PD NMSS and PDQ-39 were administered at baseline and post-eradication (6 and 12 weeks). Levodopa 'onset' time and ON-duration were recorded.
  
  
  RESULTS
  Of 82 patients recruited, 27 (32.9%) had positive UBT. H. pylori-positive patients had significantly poorer total UPDRS (p = 0.005) and PDQ39 (p<0.0001) scores compared to H. pylori-negative patients. At 12 weeks post-eradication, the mean levodopa onset time shortened by 14 minutes (p = 0.011). The mean ON duration time increased by 56 minutes at week 6 (p = 0.041) and 38 minutes at week 12 (p = 0.035). The total UPDRS scores (p<0.0001), scores for parts II (p = 0.001), III (p<0.0001) and IV (p = 0.009) were significantly better. The total PDQ-39 scores (p = 0.001) and subdomains mobility (p = 0.002), ADL (p = 0.001), emotional well being (p = 0.026) and stigma (p = 0.034) significantly improved. The PD NMSQ did not show significant improvement.
  
  
  CONCLUSIONS
  H. pylori eradication improved levodopa onset time, ON duration, motor severity and quality of life parameters. Screening and eradication of H. pylori is inexpensive and should be recommended in PD patients, particularly those with erratic response to levodopa.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02112812.
authors.affiliation: Neurology Unit, Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Hasriza
authors.initials: H
authors.lastname: Hashim
authors.affiliation: Neurology Unit, Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Shahrul
authors.initials: S
authors.lastname: Azmin
authors.affiliation: Neurology Unit, Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Hamizah
authors.initials: H
authors.lastname: Razlan
authors.affiliation: Neurology Unit, Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Nafisah Wan
authors.initials: NW
authors.lastname: Yahya
authors.affiliation: Neurology Unit, Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Hui Jan
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Department of Community Health, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: M Rizal Abdul
authors.initials: MR
authors.lastname: Manaf
authors.affiliation: Neurology Unit, Department of Medicine, UKM Medical Center, Kuala Lumpur, Malaysia.
authors.forename: Norlinah Mohamed
authors.initials: NM
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000658:Amoxicillin / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D001944:Breath Tests; D017291:Clarithromycin / Q000008:administration & dosage / Q000627:therapeutic use; D015897:Comorbidity; D004359:Drug Therapy, Combination / Q000379:methods; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D007980:Levodopa / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000188:drug therapy* / Q000382:microbiology* / Q000473:pathology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000978:Antiparkinson Agents; D007980:Levodopa; D000658:Amoxicillin; D017291:Clarithromycin; D064098:Esomeprazole