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Background  Previous studies have demonstrated a higher prevalence of  Helicobacter pylori (H. pylori)  infection in patients with Parkinson's disease (PD) compared to controls.  H. pylori  infection affects levodopa absorption and its eradication significantly improves clinical response to levodopa. Here, we studied the prevalence of  H. pylori  infection and its eradication effects among our PD patients.    Methods  A prospective study involving idiopathic PD patients on levodopa therapy.  13 C-urea breath test (UBT) was used to detect  H. pylori . UBT-positive patients were given standard eradication therapy and followed up at 6 and 12 weeks in an open label single arm design. Repeat UBT was performed at 12 weeks. The UPDRS, PD NMQ, PD NMSS and PDQ-39 were administered at baseline and post-eradication (6 and 12 weeks). Levodopa ‘onset’ time and ON-duration were recorded.    Results  Of 82 patients recruited, 27 (32.9%) had positive UBT.  H. pylori -positive patients had significantly poorer total UPDRS (p = 0.005) and PDQ39 (p<0.0001) scores compared to  H. pylori -negative patients. At 12 weeks post-eradication, the mean levodopa onset time shortened by 14 minutes (p = 0.011). The mean ON duration time increased by 56 minutes at week 6 (p = 0.041) and 38 minutes at week 12 (p = 0.035). The total UPDRS scores (p<0.0001), scores for parts II (p = 0.001), III (p<0.0001) and IV (p = 0.009) were significantly better. The total PDQ-39 scores (p = 0.001) and subdomains mobility (p = 0.002), ADL (p = 0.001), emotional well being (p = 0.026) and stigma (p = 0.034) significantly improved. The PD NMSQ did not show significant improvement.    Conclusions    H. pylori  eradication improved levodopa onset time, ON duration, motor severity and quality of life parameters. Screening and eradication of  H. pylori  is inexpensive and should be recommended in PD patients, particularly those with erratic response to levodopa.    Trial Registration  ClinicalTrials.gov  NCT02112812

Eradication of Helicobacter pylori Infection Improves Levodopa Action, Clinical Symptoms and Quality of Life in Patients with Parkinson's Disease