Long term changes in platelet counts afterH. pylorieradication in non-ITP patients

Abstract

Helicobacter pylori eradication is becoming a first-line therapy against idiopathic thrombocytopenic purpura (ITP) and its long term efficacy has already been reported. In contrast, eradication therapy reduced peripheral platelets in non-ITP patients 8 weeks later. To confirm the long term efficacy of Helicobacter eradication on platelet counts in non-ITP patients, we evaluated changes in peripheral platelet counts in endoscopically diagnosed patients with Helicobacter infection. Endoscopically diagnosed patients with Helicobacter infection received eradication therapy using amoxicillin (1500 mg/day), clarithromycin (400 mg/day) and lansoprazole (60 mg/day). The changes in platelet counts after Helicobacter eradication were serially evaluated for as long as 3 years or more. In total, 294 patients were enrolled: 243 patients successfully received eradication therapy and 51 were unsuccessfully treated. As a whole, peripheral platelet counts significantly decreased after Helicobacter eradication, being reduced by more than 1.0 × 10⁹/l by 5-6 months, 1 year, 2 years and 3 years or more (from 24.2+/-5.6 to 23.1+/-5.0, 23.0+/-5.0, 22.1+/-4.5, 22.4+/-5.6, and 21.6+/-5.3 × 10⁹/l: p = <0.0001, <0.0001, 0.0001, 0.0052, and <0.0001, respectively). Helicobacter pylori eradication finally reduced peripheral platelet counts around 2.0 × 10⁹/l in non-ITP patients. There was a definite difference in platelet regulation by Helicobacter pylori between ITP and non-ITP patients. These bivalent effects, upregulation and downregulation, on the peripheral platelet induced by Helicibacter pylori infection appeared to originate from quite different mechanisms.

<i>Helicobacter pylori</i> Upregulates Peripheral Platelet Counts Mainly in Female Patients

“…In addition, we previously reported a reduction in peripheral platelet counts of around 2.0 × 10 9 /l after eradication therapy unaware of any sex difference [3]. The previous reports and the current data indicate that females showed higher platelet counts by 2–4 × 10 9 /l than males [4,6,8,10,11,15,16,17,18].…”

“…Eradication of Helicobacter pylori is now accepted as a first-line therapy in patients with idiopathic thrombocytopenic purpura [1], whereas such treatment can decrease peripheral platelet counts in non-idiopathic thrombocytopenic purpura patients [2,3]. Many factors have been reported to influence peripheral platelet counts, such as smoking, sex difference, ethnicity and others [4,5,6,7,8,9,10,11,12,13,14,15,16,17,18].…”

Extragastric Manifestations of Helicobacter pylori Infection

“…focused on a peculiar interaction between H. pylori infection and peripheral platelet count in patients without ITP. In particular, the authors reported a significant decrease in peripheral platelet counts in patients with H. pylori infection, after its successful eradication [15]; the clinical significance of such a phenomenon is still unclear. A study conducted by Gursel et al.…”

Relationship between the Level of &lt;i&gt;Helicobacter pylori&lt;/i&gt; and Number of Platelets in Non-ITP Patients Who Underwent Gastroscopy

“…A significant drop in peripheral blood platelet counts was observed in non-ITP patients [16]. Our patient group had not any primary of secondary disease which might affect platelet counts, and they had not received H. pylori eradication therapy.…”