Original Communication

Journal of Neurology

, Volume 256, Issue 5, pp 758-767

First online:

Eradication of Helicobacter pylori may be beneficial in the management of Alzheimer’s disease

  • Jannis KountourasAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki Email author 
  • , Marina BozikiAffiliated withB’ Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki
  • , Emmanuel GavalasAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki
  • , Christos ZavosAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki
  • , Nikolaos GrigoriadisAffiliated withB’ Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki
  • , Georgia DeretziAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki
  • , Dimitrios TzilvesAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki
  • , Panagiotis KatsinelosAffiliated withDepartment of Endoscopy and Motility Unit, Central Hospital
  • , Magda TsolakiAffiliated withThird Neurological Clinic, Papanikolaou Hospital, Aristotle University of Thessaloniki
    • , Dimitrios ChatzopoulosAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki
    • , Ioannis VenizelosAffiliated withDepartment of Gastroenterology, Second Medical Clinic, Ippokration Hospital, Aristotle University of Thessaloniki

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Abstract

Infectious agents have been proposed as potential causes of Alzheimer’s disease (AD). Recently, we documented a high prevalence of Helicobacter pylori (Hp) infection in patients with AD. We aim to access the effect of Hp eradication on the AD cognitive (MMSE: Mini Mental State Examination and CAMCOG: Cambridge Cognitive Examination for the Elderly) and functional (FRSSD: Functional Rating Scale for Symptoms of Dementia) status parameters. In the first part of the study, a total of 50 consecutive patients with AD and 30 age-matched anaemic controls underwent an upper gastrointestinal endoscopy, and gastric mucosal biopsies were obtained to detect the presence of Hp infection by histologic analysis and rapid urease test. Serum anti-Hp-specific IgG level was analysed by enzyme-linked immunosorbent assay. In the second part, Hp-positive AD patients received a triple eradication regimen (omeprazole, clarithromycin and amoxicillin), and all patients were followed up for 2 years, while under the same treatment with cholinesterase inhibitors. Hp was detected in 88% of AD patients and in 46.7% of controls (P < 0.001). Hp eradication was successful in 84.8% of treated patients. At the 2-year clinical endpoint, cognitive and functional status parameters improved in the subgroup of patients where Hp eradication was successful (< 0.001 and P = 0.049 for MMSE and CAMCOG, respectively; < 0.001 for FRSSD), but not in the other patients. Hp eradication may positively influence AD manifestations, suggesting a possible common link between Hp and AD.

Keywords

Alzheimer’s disease Helicobacter pylori Histologic analysis Rapid urease test