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Shifting Rehab Paradigms

H. pylori and Parkinson's Disease

Published January 26, 2017 2:58 PM by Viktoriya Friedman

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.



1) 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.


Thank you for bringing this to our attention and making us more aware of the interaction between H. pylori and levodopa. As a student this is the first time I have heard of this. Throughout my clinical rotations I have treated patients with PD, but never once thought about the possibility that their medication may not be fully working due to the presence of bacteria interfering with it. I think this is something patients should be made aware of, especially if they feel their medication is not working as it had in the past. Physical therapists can definitely be the one to pinpoint that something is not right, and recommend the patient go to their PCP to check for H. pylori. I hate that this is not more widely acknowledged because if it really is present in almost a third of those with PD then this is something that really needs to be addressed. Thank you again for this blog, as I will keep it in mind when treating patients with PD.

Laura, Physical Therapy - SPT, ECU April 2, 2017 11:08 AM
Greenville NC

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