Objective: To determine the effect of Helicobacter pylori (H. pylori) eradication therapy on the Movement Disorder Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part III motor score in patients with Parkinson’s disease (PD) and H. pylori infection in northern Mexico.

Background: PD is a neurodegenerative disorder resulting from complex interactions between genetic and environmental factors [1]. Evidence supports a bidirectional communication between the gut microbiota and the central nervous system, known as the microbiota-gut–brain axis (MGBA) [2]. H. pylori, a bacterium that colonizes the gastric mucosa, infects approximately 50% of the global population and up to 66% of individuals in Mexico [3,4,5]. Through mechanisms related to the MGBA, H. pylori infection may contribute to PD development and progression and may also impair levodopa absorption and bioavailability [6]. Although H. pylori eradication has been associated with improvement in motor symptoms in PD, evidence in the Mexican population remains scarce [7,8].

Method: We conducted an single-center longitudinal cohort study in 20 patients with PD treated with levodopa and confirmed H. pylori infection by stool antigen testing. Participants received eradication therapy during clinical follow-up. MDS-UPDRS Part III motor scores were compared at baseline and 12 weeks after treatment. Stool antigen testing was repeated at 8 weeks to confirm eradication. Participants with poor treatment adherence or persistent H. pylori infection during follow-up were excluded.

Results: The mean age was 59.9 ± 9.09 years, and 90% were male [Table 1]. The total MDS-UPDRS Part III score decreased from 35.2 ± 12.33 at baseline to 28.35 ± 12.35 at 12 weeks, with a mean reduction of 6.85 ± 4.89 points in paired analysis (p < 0.001). Significant improvements were observed in items 3.5 (hand movements), 3.6 (pronation–supination movements of the hands), 3.7 (toe tapping), 3.8 (leg agility), and 3.14 (global spontaneity of movement) [Table 2].

Conclusion: H. pylori eradication may improve motor symptoms in patients with PD in the Mexican population, particularly bradykinesia. These findings highlight the potential clinical relevance of screening for and treating H. pylori infection in patients with PD receiving levodopa therapy.

Table 1.

Table 2.

References: 1.Kulcsarova K, Skorvanek M, Postuma RB, Berg D. Defining Parkinson’s Disease: Past and Future. Journal of Parkinson’s Disease. 2024 Oct 1;14(s2):S257–71.
2. Loh JS, Mak WQ, Tan LKS, Ng CX, Chan HH, Yeow SH, et al. Microbiota–gut–brain axis and its therapeutic applications in neurodegenerative diseases. Signal Transduction and Targeted Therapy. 2024 Feb 16;9(1):37.
3. Gravina AG, Priadko K, Ciamarra P, Granata L, Facchiano A, Miranda A, et al. Extra-Gastric Manifestations of Helicobacter pylori Infection. Journal of Clinical Medicine. 2020 Nov 30;9(12):3887.
4. Katelaris P, Hunt R, Bazzoli F, Cohen H, Fock KM, Gemilyan M, et al. Helicobacter pylori World Gastroenterology Organization Global Guideline. Journal of Clinical Gastroenterology. 2023 Feb;57(2):111–26.
5. Ladrón-de-Guevara L, Bornstein-Quevedo L, González-Huezo S, Castañeda-Romero B, Costa FG, di Silvio-López M. Erradicación de Helicobacter pylori en México con un esquema basado en levofloxacina versus la triple terapia estándar: resultados de un estudio clínico de fase iiib, abierto, aleatorizado, de no inferioridad. Revista de Gastroenterología de México. 2019 Jul;84(3):274–83.
6. Varesi A, Campagnoli LIM, Fahmideh F, Pierella E, Romeo M, Ricevuti G, et al. The Interplay between Gut Microbiota and Parkinson’s Disease: Implications on Diagnosis and Treatment. International Journal of Molecular Sciences. 2022 Oct 14;23(20):12289.
7. Hashim H, Azmin S, Razlan H, Yahya NW, Tan HJ, Manaf MRA, et al. Eradication of Helicobacter pylori Infection Improves Levodopa Action, Clinical Symptoms and Quality of Life in Patients with Parkinson’s Disease. PLoS ONE. 2014 Nov 20;9(11):e112330.
8. Liu H, Su W, Li S, Du W, Ma X, Jin Y, et al. Eradication of Helicobacter pylori infection might improve clinical status of patients with Parkinson’s disease, especially on bradykinesia. Clinical Neurology and Neurosurgery. 2017 Sep;160:101–4.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/impact-of-helicobacter-pylori-eradication-on-mds-updrs-part-iii-motor-score-in-patients-with-parkinsons-disease-a-prospective-cohort-study-in-northern-mexico/