MedicalHypotheses(1996)47, 413--414

© PearsonProfessionalLtd 1996

Gastric Helicobacter Pylori Infection as a

Cause of Idiopathic Parkinson Disease and
Non-Arteric Anterior Optic Ischemic
Neuropathy
E. ALTSCHULER

UC San Diego School of Medicine 0606, and Brain and Perception Laboratory 0109, 9500 Gilman Drive,
La Jolla, CA 92093-0109 and Lawrence Livermore National Laboratory, Institute for Scientific Computing
Research, L-416 Livermore, CA 94551, USA (Correspondence to: EA at UC San Diego. Teh (+1) (619)
534-7907; Fax: (+ 1) (619) 534-7190)

Abstract - - The mechanisms of pathogenesis for both idiopathic Parkinson disease and non-
arteritic anterior optic ischemic neuropathy are unknown. A study has shown that, in both
diseases, there is a higher prevalence of gastrointestinal ulcers than in age- and sex-matched
controls or than in the reported rates for the general population. It is proposed that gastric
Helicobacter pylori infection may be a cause of both these diseases.

Almost 175 years ago, British physician and surgeon
John Abernethy wrote, 'If I could set all the digestive
organs to rights . . . I should do better than if I dis-
covered a philosopher's stone, and have the knowl-
edge of the art of prolonging life' (1). Abernethy
thought that the association of ulcers and other
medical problems was so important that he devoted
nearly a quarter of his complete works (2) to the
discussion of such connections. Among the conditions
Abernethy thought associated with ulcers were heart
disease, dermatologic problems, and general nervous
system disorder (2). The importance placed on ulcers
by 19th-century physicians such as Abernethy faded
in this century as ulcers and any related conditions
tended to be dismissed as the result of poor eating
habits or general bad living. This more recent view
changed with the announcement by Warren and
Marshall that they had cultured a Gram-negative
bacteria (now known as Helicobacter pylori) from
patients with gastritis and peptic ulceration (3). Since
then, H. pylori has been shown to be associated with
the majority of cases of gastritis and gastrointestinal
ulcers (especially duodenal ulcers), and it seems now
a good percentage of gastric carcinomas as well (4).
Also, a number of recent studies have shown a statis-
tically significant increased incidence of H. pylori
infection in patients with coronary heart disease
(5, 6). In two studies, a single patient was apparently
cured of eczema (7) and Henoch-Sch6nlein purpura
(8) by H. pylori eradication. Here, I suggest two
other diseases - idiopathic Parkinson disease (PD)
and non-arteritic anterior optic ischemic neuropathy
(AION) - which might be associated with H. pylori
infection.
PD has an incidence of roughly 1 person in 1000
in the west (9). While a small percentage of cases of

Date received26 February1996

Date accepted9 April 1996
413
414
PD are genetic (9), and a handful of people have de-
veloped Parkinsonism by intravenous injection of 1-
methyl-4-phenyl- 1,2,5,6-tetrahydropyridine (MPTP)
(10,11), the etiology of the majority of PD cases is
idiopathic. PD has long been associated with gastro-
intestinal problems (12). Indeed, James Parkinson
himself (13) felt that there might be some causative
relationship of gastrointestinal (G1) problems to PD.
In a study of 200 PD patients and 200 age- and sex-
matched controls, Strang noted a statistically signifi-
cant higher incidence of ulcers (diagnosed by X-ray
or surgery) in the PD patients compared to the con-
trois (14). Interestingly, the ulcers typically preceded
a PD diagnosis by many years - 10-20 years (14).
How might gastric H. pylori infection cause PD?
Perhaps H. pylori is synthesizing or playing a role
in a synthesis pathway for MPTP or some analogous
molecule. Ramsden and Williams (15) suggested one
possible biosynthetic route tor MPTP, and Fellman
and Nutt noted that a gut micro-organism might
produce MPTP by this synthesis mechanism (16).
AION, the marked disturbance of vision after loss
of blood flow to the eye, was observed more than
2500 years ago by Hippocrates, but the mechanism
for its pathogenesis remains unknown (17). A recent
study of 406 AION patients showed a statistically
significant increased prevalence of gastrointestinal
ulcers in AION patients compared with the preva-
lences reported in the general population (18). Based
on examination of a number of cases, Hayreh suggest-
ed that G1 bleeding may be the cause of the ischemia
(17). Infection with H. pylori may predispose an
individual to such G1 bleeding.
There is little doubt that idiopathic PD and AION
have multiple etiologies. However, we are currently
looking to see if there is an increased prevalence of
H. pylori infection in PD or AION patients, or if there
is an association of a particular strain of H. pylori
with either of these diseases. If so, perhaps by era-
dication of H. pylori we can fulfil, to some extent,
Abernethy's program.
Acknowledgements
I would like to thank M. Brody, C. W. Shults, M. Koss, R. Rapier,
MEDICALHYPOTHESES
and V.S. Ramachandran for helpful discussions. The work was
partially supported by a Weiss fellowship for preventative
medicine. The work undertaken at Lawrence Livermore National
Laboratory was performed under the auspices of the US
Department of Energy under Contract No. W-7405-Eng-48.
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