Does Helicobater pylori initiate or perpetuate immune thrombocytopenic purpura?

Abstract

To determine the prevalence of Helicobacter pylori (H pylori) infection in North American patients with immune thrombocytopenic purpura (ITP) and the effect of H pylori eradication on the platelet count, a prospective study was performed. Seventy-four patients aged 10 years and older (mean age of 41 years) with chronic ITP and a platelet count below 60 ؋ 10 9 /L were enrolled. H pylori infection was found in 22% of patients by means of a breath test and could not be predicted by gastrointestinal symptoms. H pylori-positive patients (52.5 years of age) were older than H pylori-negative patients (38.5 years of age; P ‫؍‬ .0035). Fifteen of the 16 H pyloripositive patients were treated and the bacteria was eradicated in 14 (93%). After 3 months, a significant response (platelet count > 50 ؋ 10 9 /L and doubling the initial count) was observed in only one patient. After a median follow-up of 11.5 months, none of the 14 patients had responded. Ten H pylori-negative patients treated with the same regimen also did not increase their platelet counts. In conclusion, unlike several previous reports, this study does not implicate H pylori in the pathogenesis of ITP since the prevalence of H pylori infection was low and eradication of H pylori did not positively influence the course of the ITP. (Blood.

Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

“…The administration of eradication therapy to H pylori-negative patients with ITP failed to show any platelet increase in all treated patients, as observed by others, 8,15,32,41,43 suggesting the crucial role of bacterium eradication rather than an effect of antibiotics by itself.…”

“…[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][28][29][30][31][32][33][34][35] The prevalence (51%) of bacterium …”

Helicobacter pylori eradication: Novel therapy for immune thrombocytopenic purpura? A review of the literature

“…Our review of 13 published studies with combined data from 193 patients indicates an overall platelet response rate of 52% (Table I). However, several cohorts document little to no platelet response to H. pylori eradication therapy [19,56,57]. Unfortunately, the heterogeneity of populations treated, the variable study designs, and the different definitions for platelet response complicate the direct comparison of results between cohorts.…”

“…It was evident that some studies allowed concurrent ITP therapy but did not stipulate whether changes to this therapy were made in the post-eradication phase [13,20]. Some authors required a 1-3 month washout period of no therapy prior to eradication [57], while others allowed concurrent ITP therapy that had been stable for 1-6 months prior to eradication [19,56]. In some cases, the authors did not allow changes to concurrent ITP therapy after the eradication therapy had begun [22,29].…”

H. pylori and platelet counts

“…[6][7][8][9][10] How HP infection might modulate the thrombocytopenia in ITP remains highly debated. Some authors have proposed that there may be no link between HP and ITP, 11,12 while there is a great deal of data, particularly from eastern Asia, which would suggest a benefit in determining the HP status of ITP patients and eradicating HP in those with confirmed infection. [13][14][15] This discrepancy in data is possibly explained by the variations in study design, small study cohorts, heterogenous patient populations, and different treatment regimens and documentation of HP clearance.…”