H. pylori and Parkinson's disease: Meta-analyses including clinical severity

Efthimios Dardiotis; Zisis Tsouris; Alexios-Fotios A Mentis; Vasileios Siokas; Amalia Michalopoulou; Maria Sokratous; Metaxia Dastamani; Dimitrios P Bogdanos; Georgia Deretzi; Jannis Kountouras

doi:10.1016/j.clineuro.2018.09.039

H. pylori and Parkinson's disease: Meta-analyses including clinical severity

Clin Neurol Neurosurg. 2018 Dec:175:16-24. doi: 10.1016/j.clineuro.2018.09.039. Epub 2018 Oct 1.

Affiliations

¹ Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece. Electronic address: edar@med.uth.gr.
² Department of Neurology, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
³ Public Health Laboratories, Hellenic Pasteur Institute, Athens, Greece; Department of Microbiology, University Hospital of Larissa, University of Thessaly, Larissa, Greece.
⁴ Department of Rheumatology and Clinical Immunology, University Hospital of Larissa, University of Thessaly, Larissa, Greece; Cellular Immunotherapy & Molecular Immunodiagnostics, Biomedical Section, Centre for Research and Technology-Hellas (CERTH), Institute for Research and Technology-Thessaly (IRETETH), Larissa, Greece.
⁵ Department of Neurology, Papageorgiou General Hospital, Thessaloniki, Greece.
⁶ Department of Medicine, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

PMID: 30308319
DOI: 10.1016/j.clineuro.2018.09.039

Abstract

The exact etiology of Parkinson's disease (PD) remains unclear. Some evidence supports Helicobacter pylori infection as a trigger or driving event, but detection and eradication of H. pylori are not part of PD management. The aims of this case-control study and meta-analysis were to determine (i) the prevalence of H. pylori infection in PD patients, (ii) associations between H. pylori infection and clinical status, and (iii) differences in motor status in PD patients before and after H. pylori eradication. A literature search was performed using the PubMed database. The prevalence of H. pylori infection in PD, its association with the unified Parkinson's disease rating scale (UPDRS), and the association of H. pylori eradication therapy with the UPDRS-III score were determined by calculating the odds ratios (OR) and the standardized mean differences (SMD) with 95% confidence intervals (CI). Fixed- and random-effects models were applied. Ten studies were included in the first meta-analysis (5043 PD patients, 23,449 HCs); H. pylori infection prevalence was higher in PD patients than in HCs [OR (95% CI): 1.47 (1.27, 1.70), P_z<0.00001]. In seven studies reporting UPDRS scores (150 H. pylori infected, 228 non-infected PD patients), there was a significant association between H. pylori infection and mean UPDRS scores [SMD (95% CI): 0.33 (0.12, 0.54), P_z = 0.003]. Regarding H. pylori eradication, in five studies (90 PD patients), there was a significant reduction in UPDRS-III scores after treatment [SMD (95% CI): 6.83 (2.29, 11.38), P_z = 0.003]. In conclusion, the present meta-analysis revealed a higher prevalence of H. pylori infection in PD patients suggesting that H. pylori may contribute to PD pathophysiology. In addition, the significantly lower UPDRS scores in non-infected PD patients and in patients after H. pylori eradication therapy demonstrate that the infection may deteriorate the clinical severity of the disease.

Keywords: Eradication; Helicobacter pylori; Infection; Meta-analysis; Parkinson’s disease; UPDRS.

Publication types

Meta-Analysis
Review

MeSH terms

Case-Control Studies
Helicobacter Infections / diagnosis*
Helicobacter Infections / epidemiology
Helicobacter pylori / isolation & purification*
Humans
Observational Studies as Topic / methods
Parkinson Disease / diagnosis*
Parkinson Disease / epidemiology
Randomized Controlled Trials as Topic / methods
Severity of Illness Index*