Influence of Helicobacter pyloriEradication on Motor Fluctuation Patternsin Advanced Parkinson’s Disease: AQuasi-experimental Evaluation UsingMDS-Unified Parkinson’s DiseaseRating Scale

Abstract

Background: Parkinson’s disease (PD) represents a major neurodegenerative condition globally, and its contribution to the overall neurological disease burden is expected to rise markedly by 2040. Motor complications, including wearing-off phenomena, on-off fluctuations, and dyskinesias, remain major therapeutic challenges in advanced PD. Emerging evidence suggests that Helicobacter pylori infection may worsen motor symptoms by impairing gastrointestinal absorption of levodopa. Methods: This prospective quasi-experimental investigation was carried
out at Saveetha Medical College and Hospital over a 12-month period, from January to December 2024. The study included 20 individuals diagnosed with advanced PD who experienced motor response fluctuations. Patients
confirmed to be H pylori positive through endoscopic biopsy or stool antigen assessment were treated with an eradication regimen consisting of amoxicillin 500 mg thrice daily for 1 week and vonoprazan 20 mg once daily
for 2 weeks. Motor performance was evaluated with the MDS-unified PD rating scale (UPDRS) Part III scale before treatment and during follow-up visits at 6 and 12 weeks after therapy. Results: The eradication rate was
70%. Compared with patients without infection, those with H. pylori positivity belonged to an older age group and developed PD at a significantly later age (P < 0.05). MDS-UPDRS Part III scores improved significantly following eradication therapy, particularly in the OFF medication state. Lifestyle factors, including smoking and dietary intake, were not significantly associated with treatment outcomes. The observed results indicate that H. pylori infection may be linked to poorer motor regulation in PD, while eradication treatment may lessen fluctuation severity by enhancing the availability of absorbed levodopa. Conclusion: Treatment aimed at eliminating H. pylori may offer motor benefit in advanced PD by improving the gastrointestinal handling and absorption of levodopa. Larger multicenter studies with microbiological confirmation of eradication and longer follow-up are required to validate these findings and further explore gut-brain axis mechanisms. Region-specific eradication protocols considering antimicrobial resistance patterns are also warranted