SYDNEY, Australia — Patients with Parkinson's disease (PD) and Helicobacter pylori infection may respond better to levodopa and see their symptoms ease once the infection is eradicated, new research confirms.

"Screening and eradication of H pylori should be recommended in all PD patients, particularly those with erratic response to levodopa," the study team concludes.

"I think it would be a pity to miss this infection in our patients and I believe we should incorporate this in our clinical practice, as it is quite inexpensive to diagnose and treat," Norlinah Mohamed Ibrahim, MD, from the Neurology Unit, UKM Medical Centre, Kuala Lumpur, Malaysia, told Medscape Medical News.

She presented the study results during a late-breaker poster session at the Movement Disorder Society (MDS) 17th International Congress of Parkinson's Disease and Movement Disorders.

H pylori Prevalent in PD

Prior studies have demonstrated that H pylori infection is prevalent in patients with PD, it affects levodopa absorption and its eradication can improve clinical response to levodopa. The new study from Malaysia largely confirms these findings.

Among 82 patients with idiopathic PD who were receiving levodopa therapy, 27 (32.9%) had a positive result on a 13C-urea breath test.

Compared with H pylori–negative patients, H pylori–positive patients had significantly poorer scores on the total Unified Parkinson's Disease Rating Scale (UPDRS) (P = .005) and the 29-item Parkinson's Disease Questionnaire (PDQ39) (P < .0001).

Twelve weeks after the infection was successfully eradicated with antibiotic therapy, levodopa "onset" time significantly decreased (P = .023) and "on" time significantly improved (P = .023), the researchers say.

The total UPDRS scores (P < .0001) and scores for parts II (P < .0001), III (P = .001), and IV (P < .009) were also significantly better 12 weeks after eradication, as were total PDQ39 scores (P < .0001) and the subdomains of mobility (P = .001), activities of daily living (P < .0001), stigma (P = .047), and cognition (P = .01).

"Robust" Improvement With Eradication

"It was our hypothesis that H pylori impairs the absorption of levodopa and its eradication would in fact improve clinical symptoms. And indeed, we were very impressed by the robust improvement in all the parameters, as early as 6 weeks of eradication and was sustained at least for 3 months," Dr. Mohamed Ibrahim told Medscape Medical News.

"This indicates that eradication of H pylori affects treatment of patients with PD, especially those with erratic response to levodopa. As PD patients are more predisposed to having this infection, eradication of the infection will not only help in their clinical outcome but also reduces their incidence of gastric and duodenal ulcers, and reduced risk of gastric malignancies," the lead investigator added.

Dr. Mohamed Ibrahim said she is collaborating with a colleague on a "more robust" study mainly addressing the clinical effects of H pylori eradication in patients with PD, but also the effects on other measures, such as inflammation.

The authors have disclosed no relevant financial relationships.

Movement Disorder Society (MDS) 17th International Congress of Parkinson's Disease and Movement Disorders. Abstract LBA-32. Presented June 18, 2013.


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