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H. pylori Eradication Improves Levodopa Absorption

1. Helicobacter pylori eradication and L-dopa absorption in patients with PD
and motor fluctuations
M Pierantozzi, A Pietoiusti, L Brusa, S Galati, A Stefani, G Lunardi, E
Fedele, G Sancesario, G Bernardi, A Bergamaschi, A Magrini, P Stanzione, A
Galante
Neurology 2006;66:1824-1829

Eradicating H. pylori infection improves levodopa pharmacokinetics and
increases on time in patients with motor fluctuations, according to this
double-blind study.

Thirty-four PD patients with motor fluctuations and H. pylori (HP) infection
were randomized to receive either eradication therapy (amoxicillin,
chlarithromycin, and omeprazole) or antioxidant therapy (allopurinol, "chosen
for its antioxidant properties, able to heal duodenal ulcer"). Two of 19
patients in the eradication group dropped out. Of the remaining 17, 15 became
HP-negative after 3 months, whereas none of the antioxidant group did.

Follow-up endoscopy revealed significantly greater improvement in gastritis
and duodenitis in the eradication group as well. The eradication group had
significantly higher area under the curve and plasma concentration for a
single levodopa dose. Average daily on time improved with eradication
treatment by over 1 hour, and worsened with antioxidant treatment.

The authors conclude, "L-dopa pharmacokinetic changes after HP eradication may
represent an attractive therapeutic opportunity for those patients with
fluctuating clinical response to L-dopa".

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