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From the IRCCS Santa Lucia Foundation (M.P., L.B., S.G., A.S., G.S., G.B., P.S.) and Departments of Neuroscience (M.P., L.B., S.G., A.S., G.S., G.B., P.S.), Internal Medicine (A.P., A.G.), and Occupational Medicine (A.B., A.M.), "Tor Vergata" University, and S. Raffaele Hospital (A.P., A.G.), Rome, and Departments of Oncology, Biology, Genetics, Pharmacology, and Neuroscience (G.L.) and Experimental Medicine (E.F.), Pharmacology and Toxicology Division, Genoa University, Italy.
Address correspondence and reprint requests to Dr. A. Pietroiusti, Department of Internal Medicine, "Tor Vergata" University, Viale Montpellier 1, 00133, Rome, Italy; e-mail: pietroiusti{at}med.uniroma2.it
Objective: To investigate if Helicobacter pylori (HP) eradication could make an effective and long-lasting improvement in the pharmacokinetic and clinical response to l-dopa in patients with Parkinson disease (PD) and motor fluctuations.
Methods: In a group of 34 HP-infected, motor-fluctuating patients with PD, the short-term (1-week) and long-term (3-month) beneficial effect of HP eradication (n = 17) was investigated in a double-blind fashion in comparison with a generic antioxidant treatment (n = 17), by means of pharmacokinetic, clinical, and gastrointestinal assessments. Results were compared with placebo treatment.
Results: Differently from the antioxidant-treated patients, the HP-eradicated patients showed a significant increase of l-dopa absorption, which was coupled with a significant improvement of clinical disability and with a prolonged "on-time" duration, whereas gastritis/duodenitis scores significantly decreased in line with a better l-dopa pharmacokinetics.
Conclusions: These data demonstrate a reversible Helicobacter pylori (HP)–induced interference with l-dopa clinical response related to the impaired drug absorption, probably due to active gastroduodenitis. Therefore, the authors suggest that HP eradication may improve the clinical status of infected patients with Parkinson disease and motor fluctuations by modifying l-dopa pharmacokinetics.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the June 27 issue to find the title link for this article.
Commentary, see page 1791
Disclosure: The authors report no conflicts of interest.
Received October 24, 2005.
Accepted in final form March 22, 2006.
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Neurology 2006 66: 1791.
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