Effect of Helicobacter pylori eradication on platelet count in children with chronic idiopathic thrombocytopenic purpura

Abstract

Recent reports have suggested, particularly in adults, an association between Helicobacter pylori infection (HPI) and chronic idiopatic thrombocytopenic purpura (cITP) with improvement of platelet count after eradication therapy. We investigated the association of HPI and cITP and the effect of HP eradication therapy on thrombocytopenia in a population of 24 children of both sexes mean age 8.0+/-0.28 years (range 5.4-10.7 years), affected by cITP (PLT <or=50 x 10(9)/l) lasting more than 6 months. HPI was investigated by Helicobacter pylori stool antigens (HpSA). In eight out 24 patients (33.3%) HP infection was identified positive and bacterial eradication was successful following 7 days of triple therapy (amoxicillin, clarithromicin and proton pump inibitors). A follow-up of platelet count was performed for 1 year after HpSA detection. Six out eight patients (75%) had total recovery of platelet count during the first year after bacterial eradication (PLT before therapy 32.5+/-3.5 x 10(9)/l; after 1 year 275+/-106.06 x 10(9)/l) (P<0.05), two patients (25%) had partial recovery (PLT before therapy 30 x 10(9)/l, after 1 year 103.5 x 10(9)/l) although not reaching statistical significance (P>0.05). Non-significant differences were found in platelet count between infected and uninfected patients before eradication treatment (PLT 33.0+/-2.8 x 10(9)/l versus 34.0+/-5.75 x 10(9)/l) (P>0.05), while significant differences were observed after eradication therapy (PLT 315.0+/-7.07 x 10(9)/l versus 43.5+/-2.12 x 10(9)/l) (P<0.05). HP assessment should be performed in all cITP patients and eradication therapy should be attempted in positive cases.

Eradication of Gastric Infection by Helicobacter pylori and Chronic Idiopathic Thrombocytopenic Purpura Situation

“…We also found a significant increase in platelet count of eight patients during six months of follow-up (P < 0.001) compared with the baseline platelet count. This finding was consistent with the findings of other studies (11,12). In the study of Ferrara et al (11) on 24 patients with CITP, eight individuals (33.3%) were infected with H. pylori and eradication treatment was successfully achieved in six out of eight patients with significant increases in platelet count in all six cases.…”

“…In the study of Ferrara et al (11) on 24 patients with CITP, eight individuals (33.3%) were infected with H. pylori and eradication treatment was successfully achieved in six out of eight patients with significant increases in platelet count in all six cases. Our findings as well as that of Ferrara et al (11) highlight the effect of H. pylori infection on platelet count in CITP as a basic cause or exacerbation factor. Another study by Sato et al in Japan was performed on 53 patients with CITP (12).…”

Helicobacter pylori-associated immune thrombocytopenia: Clinical features and pathogenic mechanisms

“…Rajantie et al [29] Finland 0/17 (0) ND Jaing et al [30] Taiwan 9/22 (41) 5/9 (50) Hayashi et al [31] Japan 2/10 (20) 1/1 (100) Yetgin et al [32] Turkey 11/35 (31) 0/9 (0) Jaing et al [33] Taiwan 10/63 (16) ND Loffredo et al [34] Italy 8/39 (21) 0/8 (0) Neefjes et al [35] Netherlands 3/47 (6) 3/3 (100) Wu et al [36] Taiwan 6/32 (19) ND Bisogno et al [37] Italy 8/24 (33) 1/8 (13) Hamidieh et al [38] Iran 4/31 (13) 0/4 (0) Treepongkaruna et al [39] Thailand 16/55 (29) 0/7 (0) Ferrara et al [40] Italy 8/24 (33) 8/8 (100) Maghbool et al [41] Iran 5/30 (17) 5/5 (100) Russo et al [42] Italy 50/244 (20) 13/33 (39) patients in a subgroup of seemingly primary ITP (H. pylori-associated ITP), and H. pylori infection appears to be uninvolved in the pathogenic process of other secondary ITPs.…”

“…Table 1 summarizes the studies assessing the prevalence of H. pylori infection and platelet response after eradicating H. pylori in children with ITP. Although a Finnish study failed to detect H. pylori infection in any of 17 children with chronic ITP [29] , other studies detected H. pylori infection in a small proportion of children with chronic ITP [30][31][32][33][34][35][36][37][38][39][40][41][42] . The highest prevalence was reported in a study conducted in Taiwan, which showed an infection rate of 41% [29] .…”

Helicobacter pylori: Infektion mit lokalen Komplikationen und systemischen Auswirkungen

“…Dies wurde sowohl für Erwachsene als auch für Kinder bestätigt[23]. Man kann die Besserung der Thrombozytenzahl als eine Folge der Eradikationstherapie werten, aber der genaue pathophysiologische Mechanismus ist noch nicht abschließend geklärt.…”