Effect of Helicobacter Pylori eradication on patients with ITP: a meta-analysis of studies conducted in the Middle East

Abstract

Immune thrombocytopenia (ITP) is a bleeding disorder. Helicobacter pylori is a Gram-negative bacterium that is presumed to be associated with ITP and therapeutic response of patients. To evaluate the effect of H. pylori eradication on the platelet count of patients with ITP. To this end, we analyzed studies conducted on the association between H. pylori infection and response to therapy in patients with ITP in Western Asia, with a particular focus on the Middle East region. A systematic search of databases (PubMed/Medline, ISI Web of Science, Cochrane Central) and Google Scholar search engine results was conducted up until January 2020. The keywords included in the search were Helicobacter pylori and/or H. pylori, ITP and/or immune thrombocytopenia. Seven studies comprising a total of 228 H. pyloriinfected patients (193 with successful eradication) were included in this study. The association between H. pylori eradication and ITP was expressed as odds ratios (ORs) and 95% confidence intervals (CI). The findings showed that patients who received eradication treatment for H. pylori infection had significantly higher ORs (OR, 8.83; 95% CI, 2.03-38.35; P=0.004) than those in the non-eradicated group. Our results indicate a significant therapeutic effect of H. pylori eradication on the platelet count of patients with chronic ITP. Given the inherent limitations of this study, including the small number of patients, further studies with more patients are recommended.

Rescue Therapies for H. pylori Infection in Italy

“…Helicobacter pylori still remains a widely diffuse infection worldwide [ 1 ], and it is the main cause of both benign and malignant gastroduodenal diseases, including non-ulcer dyspepsia, peptic ulcers, gastric MALT-lymphoma and carcinoma, as well as interaction with non-steroidal anti-inflammatory drugs in causing gastroduodenal lesions [ 2 , 3 ]. Moreover, H. pylori plays a definite role in some extra-intestinal disorders, such as idiopathic thrombocytopenic purpura and idiopathic iron deficiency anemia [ 4 , 5 ], whilst the association with other diseases (neurological, dermatological, hematologic, ocular, cardiovascular, metabolic, allergic, and hepatobiliary diseases) deserves further investigation [ 6 ]. It is well known that H. pylori eradication definitely changes the natural history of peptic ulcer disease, in terms of recurrence and complications.…”

Consensus guidelines for the management of adult immune thrombocytopenia in Australia and New Zealand

“…Detection and eradication of Helicobacter pylori with subsequent remission of ITP has been reported, with highest rates of success in Asian populations 16 . In our experience, this has not been successful in most areas of Australia and New Zealand, but may be considered in patients of ethnic backgrounds where supportive data exist (Asia, Middle East, Mediterranean, Latin America), and particularly in those with mild to moderate thrombocytopenia (GRADE 2A) 17,18 . As eradication is inexpensive and treatment reasonably well tolerated, we also consider testing for H .…”

“… 16 In our experience, this has not been successful in most areas of Australia and New Zealand, but may be considered in patients of ethnic backgrounds where supportive data exist (Asia, Middle East, Mediterranean, Latin America), and particularly in those with mild to moderate thrombocytopenia (GRADE 2A). 17 , 18 As eradication is inexpensive and treatment reasonably well tolerated, we also consider testing for H . pylori before performing an irreversible procedure such as splenectomy (GRADE 2C).…”

<i>Helicobacter pylori</i> induced Immune Thrombocytopenic Purpura and perspective role of <i>Helicobacter pylori</i> eradication therapy for treating Immune Thrombocytopenic Purpura

“…In the same vein, another study by Sheema et al has also demonstrated the prevalence of H-pylori surface antigen positivity in patients of chronic ITP, as shown in Figure 2b [17] . There are many proposed mechanisms of ITP development due to H-pylori infection, such as molecular mimicry, platelets aggregation, phagocytic perturbation, increased plasmacytoid dendritic cell (pDCs) response and host immune response to H-pylori virulent factors [6] .…”

“… [5] . The etiological classification of ITP ranges from primary ITP with no identifiable cause to secondary ITP having secondary association with environmental factors, neoplastic disorders, bacterial and viral infections like hepatitis C virus (HCV), and human immunodeficiency virus (HIV), and chronic H-pylori infection [6] .…”