Abstract

Background:

Infection with Helicobacter pylori seems overrepresented in Parkinson’s disease. Clinical observations suggest a suboptimal treatment effect of levodopa in Helicobacter positive patients.

Objective:

Describe and explain the connection between a Helicobacter pylori infection of the upper gut and changes in pharmacokinetics of oral levodopa treatment in Parkinson’s disease.

Methods:

PubMed, Google Scholar, and Cross Reference search was done using the key words and combined searches: Bioavailability, drug metabolism, dyskinesia, Helicobacter, L-dopa, levodopa, motor control, pharmacodynamics, pharmacokinetics, prevalence, unified Parkinson’s disease rating scale.

Results:

The prevalence of Helicobacter pylori in Parkinson’s disease patients is reported to be about 1.6-fold higher than in a control population in some studies. Helicobacter has therefore been assumed to be linked to Parkinson’s disease, but the mechanism is unclear. As regards symptoms and treatment, patients with Parkinson’s disease on levodopa therapy and with Helicobacter pylori infection display worse motor control than those without Helicobacter infection. Eradication of the infection improves levodopa response in Parkinson’s disease, likely as a consequence of an increased oral pre-systemic bioavailability of levodopa, likely to be explained by reduced Helicobacter-dependent levodopa consumption in the stomach. In addition, small intestinal bacterial overgrowth may also have an impact on the therapeutic setting for levodopa treatment but is less well established.

Conclusion:

Eradication of Helicobacter pylori improves levodopa bioavailability resulting in improved motor control. Eradication of Helicobacter should be considered in patients with poor symptomatic control and considerable motor fluctuations.

中文翻译：

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幽门螺杆菌对左旋多巴药代动力学的影响

摘要

背景：

幽门螺杆菌感染在帕金森病中的比例似乎过高。临床观察表明，左旋多巴对幽门螺杆菌阳性患者的治疗效果不佳。

客观的：

描述并解释上消化道幽门螺杆菌感染与口服左旋多巴治疗帕金森病的药代动力学变化之间的联系。

方法：

使用以下关键词和组合搜索进行 PubMed、Google Scholar 和交叉参考搜索：生物利用度、药物代谢、运动障碍、螺杆菌、左旋多巴、左旋多巴、运动控制、药效学、药代动力学、患病率、统一帕金森病评级量表。

结果：

据报道，一些研究表明，帕金森病患者中幽门螺杆菌的患病率比对照人群高出约 1.6 倍。因此，螺杆菌被认为与帕金森病有关，但其机制尚不清楚。在症状和治疗方面，接受左旋多巴治疗且感染幽门螺杆菌的帕金森病患者比未感染幽门螺杆菌的患者表现出更差的运动控制能力。根除感染可改善帕金森病的左旋多巴反应，这可能是左旋多巴口服系统前生物利用度增加的结果，这可能是由于胃中螺杆菌依赖性左旋多巴消耗减少所致。此外，小肠细菌过度生长也可能对左旋多巴治疗的治疗环境产生影响，但尚未得到充分证实。

结论：

根除幽门螺杆菌可提高左旋多巴的生物利用度，从而改善运动控制。对于症状控制不佳和运动波动较大的患者，应考虑根除螺杆菌。