You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration. Dr. Okun is also the author of the Amazon #1 Parkinson's Best Seller 10 Secrets to a Happier Life.
The discovery that a bug in the gut called H. Pylori could underpin gastrointestinal disease and also ulcer formation was one of the most important in modern GI medicine. Why however, would H. Pylori infection be relevant to Parkinson’s disease patients, especially if 2 out of every 3 people on the planet carry the bug in their guts. It turns out that if left untreated H. Pylori may affect the absorption of Parkinson’s disease medications, and consequently affect the overall response to treatment. In this month’s What’s Hot in PD? column we will explore H. Pylori infection and Parkinson’s disease.
Back in 2006 an important paper by Pierantozzi and colleagues was published in the journal Neurology and almost went unnoticed. The researchers based in Rome identified and treated patients with H. Pylori infection, either with an anti-oxidant pill, or with an antibiotic regimen known to eradicate H. Pylori in the gut. The absorption of levodopa in these patients improved, as did the number of hours of “on” time. Later in 2008 in an article by Lee and colleagues from Samsung Medical Center in Korea, these results were verified. The onset of action of levodopa, the “on” duration of the medications, and the Parkinson’s disease scales improved more in the group treated for H. Pylori infection.
Nielsen and colleagues in 2012 examined H. Pylori infection, and the risk of Parkinson’s disease in a study published in the European Journal of Neurology. There were 4484 Danish patients included and they were drawn from the Danish Civil Registration System. The use of H. Pylori eradicating drugs was associated with a 45% increased risk of developing Parkinson’s disease. Similarly, the use of proton pump inhibitors was also associated with a 23% increased risk for the development of Parkinson’s disease. The authors speculated that chronic H. Pylori infections and also gastritis could possibly be related to the risk of developing Parkinson’s disease, though there were many methodological issues limiting the overall study interpretation.
Last week at the International Movement Disorders Society Congress held in Sydney Australia, a group from Malaysia again raised the issue of a relationship between H. Pylori and Parkinson’s disease. There were 27 of 76 Parkinson’s patients in their clinic found to be positive on a breath test that was sensitive for H. Pylori infection. After treatment with oral clarithromycin, amoxicillin, and esomeprazole the onset of action for levodopa improved, and the “on” time also improved. Parkinson’s disease rating scales and questionnaires measuring quality of life also showed positive trends following treatment (unpublished data from the Movement Disorders Society, Ibrahim, et. al. National University of Malaysia).
So, what do patients with Parkinson’s disease and family members need to know about H. Pylori infection? First, the issue as to whether H. Pylori is a risk factor for the later development of Parkinson’s disease remains unknown. Second, if an individual patient is experiencing motor fluctuations that cannot be controlled by medication adjustment this patient should consider asking their primary care doctor (or GI specialist) to check a C-urea breath test for the possible presence of H. Pylori infection. Third, the decision to treat H. Pylori should be made in consultation with the GI specialist and the neurologist, especially since the infection commonly occurs in 2/3 of the population, and the GI specialist may in some cases need to perform follow-up testing (e.g. a scope to visualize the stomach and intestines). Remember also that allergies or tolerability may alter the exact treatment regimen. Finally, motor fluctuations and medication changes should be managed by your neurologist before and after treatment for H. Pylori. It is potentially great news that for some patients with H. Pylori there may be hope for treatment that can improve the response to dopaminergic therapy.
Pierantozzi M, Pietroiusti A, Brusa L, Galati S, Stefani A, Lunardi G, Fedele E, Sancesario G, Bernardi G, Bergamaschi A, Magrini A, Stanzione P, Galante A. Helicobacter pylori eradication and l-dopa absorption in patients with PD and motor fluctuations. Neurology. 2006 Jun 27;66(12):1824-9.
Lee WY, Yoon WT, Shin HY, Jeon SH, Rhee PL. Helicobacter pylori infection and motor fluctuations in patients with Parkinson's disease. Mov Disord. 2008 Sep 15;23(12):1696-700.
Dobbs SM, Dobbs RJ, Weller C, Charlett A, Bjarnason IT, Lawson AJ, Letley D, Harbin L, Price AB, Ibrahim MA, Oxlade NL, Bowthorpe J, Leckstroem D, Smee C, Plant JM, Peterson DW. Differential effect of Helicobacter pylori eradication on time-trends in brady/hypokinesia and rigidity in idiopathic parkinsonism. Helicobacter. 2010 Aug;15(4):279-94.
Nielsen HH, Qiu J, Friis S, Wermuth L, Ritz B. Treatment for Helicobacter pylori infection and risk of Parkinson's disease in Denmark. Eur J Neurol. 2012 Jun;19(6):864-9. doi: 10.1111/j.1468-1331.2011.03643.x. Epub 2012 Jan 17.
Posted: 7/8/2013 5:52:15 AM by
Browse current and archived What's Hot in PD? articles, the National Parkinson Foundation's monthly blog for people with Parkinson's written by our National Medical Director, Dr. Michael S. Okun.
Pimavanserin and the Hope for a Better Drug for Hallucinations and Psychosis in Parkinson’s Disease
Halting of the Creatine Study
The Importance of Identifying and Treating Caregiver Strain
Putting Parkinson’s Disease Information into the Palm of Your Hand: Parkinson’s Enters the Smartphon
What Parkinson’s Disease Patients Need to Know about H. Pylori Gastrointestinal Infections
A2A Receptor Antagonists and Parkinson’s Disease Treatment
Another Setback for Trophic Factor Treatment in Parkinson's Disease
IPX066 and What Patients Really Want in New Carbidopa/Levodopa (Sinemet) Formulations
The Weather Forecast for Parkinson’s Disease Calls for Worldwide Economic Storm
Defeating the Barriers to Implementing Exercise Regimens in Parkinson’s Disease Patients
When should you start medication therapy for Parkinson’s disease?
Neurologist Care Reduces Hospitalizations in Parkinson's Disease
A Victory in Court for Parkinson's Disease Patients who Require Ongoing Rehabilitative Therapies
Given the recent FDA announcement about Mirapex (pramipexole), should I be worried about dopamine agonists?
What about the new Parkinson’s Disease Vaccine? What should I know?
Caffeine as a Potential Treatment for Parkinson’s Disease
Time to Consider GPi DBS for Parkinson’s Disease: A Shift in the Practice of Patient Selection for DBS
A New Treatment for Parkinson’s Disease-Related Constipation
Too Many Pills: Improving Delivery Systems for Parkinson’s Disease Drugs
Measuring Quality and Assessing Depression in Parkinson's Disease
Watch out for Unexpected Obstacles if You Use a Cueing Strategy to Break Freezing of Gait in Parkinson’s Disease
Pill Color, Generic Medications and Insurance Issues: Important Medication-Related Tips for the Parkinson’s Disease Patient
Are Blood Tests for Parkinson’s Disease on the Horizon?
Placing Stem Cells in Animal Models of Parkinson’s Disease: Another Important Step
Important News for the Parkinson’s Disease Community: More Evidence that Sinemet and Madopar are Not Toxic and do Not Accelerate Disease Progression
The Case for All Parkinson’s Disease Patients to be Co-managed by a Primary Care-Neurologist Team
Scientists say Research on Brain Proteins Involved in Parkinson’s Disease is “Shaping” Up
Who Actually Takes Care of Most of the Parkinson’s Patients Worldwide: The Need for Education and the Parkinson’s Toolkit
If you are Dizzy or Passing Out, it could be Your Parkinson’s Disease or Parkinson’s Disease Medications
How Will Group Visits for Parkinson’s Disease Fit into the Future of Parkinson’s Disease Care?
Why Patients Should be Wary of Chelation Therapy for Parkinson’s Disease
Opening the Door to Gene Therapy in Parkinson’s Disease: The Need for Refinement of the Technology and Approach
Does it Matter if I Can’t Get Brand Sinemet?
Should I get a DaTscan or PET scan to confirm my diagnosis of Parkinson’s disease?
A Critical Reappraisal of the Worst Drugs in Parkinson’s Disease
Environmental Risks for PD: Manganese, Welding, Mining, and Parkinsonism
Calling for the FDA to Revise the Eight Sinemet a Day Rule
Dry Cleaning Solvents and Potential Environmental Risks for Developing Parkinson’s Disease
Maintaining the Balance: Why Parkinson’s Disease Patients Need to Understand Drug Recalls, Withdrawals, and Safety Alerts
Shining a Light on Parkinson’s Disease: Optogenetics Has a Bright Future in Research
Poor Medication Management of Parkinson's Disease During Hospital Admissions: Patients and Families Can Improve Their Hospital-Based Management
Why Are Patches and Continuous Release Technology a Big Deal to Parkinson's?
Is the PD SURG Trial Another Surge Forward for DBS Therapy?
Cycling in PD in Those Who Can’t Walk: Is it Possible?
New iPS Stem Cells for PD: What Does it Mean?
Time for Comprehensive Care Networks for PD
Is Parkinson's Disease a Prion Disease?
Parkinson's Disease Linked to Gaucher's Disease
Brain Cells Keep Time Stamps: Implications for Parkinson's Disease Therapies
Is it Safe to Have an MRI with a DBS in Place?
Take Care of Your Bones as They Are Affected in Parkinson's Disease (Even in Men)
Is it Time to Start Paying Attention to Pain Symptoms in Parkinson's Disease Patients?
Glutathione Fails to Demonstrate Significant Improvement in PD Symptoms
Keeping an Eye on Trials Important to the Parkinson's Disease Patient
Increased Risk of Melanoma in Parkinson's Disease
Finally a DBS Expert Consensus Statement Aimed at Their True Customers: The Patients
Pesticides and Environmental Exposure in Parkinson's disease: Should We Stay Away From the Stink Truck?
Is Exercise Effective Treatment and Protection Against PD?
Why are Transplant Trials Struggling to Succeed in the Treatment of PD?
Are Monoamine Oxidase Inhibitors Disease Modifying or Neuroprotective in PD?
Update on Gene Therapy for Parkinson's Disease