Helicobacter Pylori (H. pylori) is a bacterium often present in upper GI tract in gastric ulcers. This bacterium has been shown to compromise levodopa absorption in the gut, thus limiting its effect. Levodopa with carbidopa (Sinemet) is often a drug of choice for patients with PD and for good reasons.
Sinemet is a dopamine agonist and helps many patients with PD improve mobility, minimize bradi and akinesia. Many patients rely on it heavily for daily functional mobility; thus if the action of this medication is compromised by patient’s enteral system due presence of H. pylori, then the symptoms of PD prevail.
So how prevalent is H.pylori infection in patients with PD? According to Hashim, H. et al, they found 32.9% of their study sample tested positive for H. pylori. Using C-urea breath test (UBT) is a non-invasive and not expensive way to test for presence of H. pylori in the gut. Eradication of this bacterium is also somewhat simple. Usually, the doctor prescribes the “triple therapies,” which includes one proton pump inhibitor and two antibiotics.
Hashim’s study revealed findings at six and 12 weeks to be very positive. Patients who tested positive for H. pylori via UBT and undergone standard tripe therapy eradication improved their mobility, motivation, ADLs, gait, “ON” time and overall quality of life as noted in standardized tests such as PDQ-39, UPDRS and others.
Though association between H. pylori and Parkinson’s disease (PD) is increasingly recognized, still very few patients actually undergo testing and its eradication. As therapists, we should be aware of this finding and advocate for our patients.
- Hashim, H., Azmin, S., Razlan H., et al. Eradication of helicobacter pylori infection improves Levodopa Action, clinical symptoms, and quality of life in Patients with Parkinson’s Disease. PLosONE9 (11) 2014.