Long-term efficacy of Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura: 7-year follow-up prospective study

Abstract

Helicobacter pylori eradication is useful for improvement of a half of patients with idiopathic thrombocytopenic purpura (ITP), but its long-term therapeutic efficacy has not been elucidated. We investigated the long-term efficacy of H. pylori eradication in 30 cases with ITP that were included in our previous study regarding the association between H. pylori infection and ITP. Twenty-one cases were positive and nine cases were negative for H. pylori infection. H. pylori eradication therapy including secondary regimen was successful in 20 cases, half (responder) of whom showed ITP remission 1 month later. Nine responders could be followed up for a long time and did not show re-infection of H. pylori. Eight of nine needed no medication except for eradication therapy. Another case remained in remission for 1 year but thereafter needed a steroid therapy due to the recurrence. Eight nonresponders could be followed up for a long time. All these cases showed a bad clinical course even though they received the other post-treatments including steroid therapy. Three of nine H. pylori-negative cases underwent eradication therapy after obtaining the written informed consent, but none of them showed improvement. Of these three cases, two cases could be followed up. Only one case remained a remission although receiving corticosteroid as a post-treatment. Conditions of H. pylori-negative ITP cases were usually unstable for a long time. H. pylori eradication has a short-term efficacy for about half of H. pylori-positive ITP patients, and the responders to the eradication therapy may receive a long-term clinical benefit without other therapies.

Romiplostim for the treatment of chronic immune thrombocytopenia in adult Japanese patients: a double-blind, randomized Phase III clinical trial

“…ITP in adults generally appears in a chronic form, with the definition of chronic ranging from ITP of at least 6 months duration to at least 12 months duration [7,[9][10][11][12]. Causal factors may include active Helicobacter pylori infection; H. pylori eradication therapy appears to improve thrombocytopenia in some ITP patients [13][14][15][16][17][18]. ITP appears to be more frequent in women, particularly between the ages of 30-60 years [10,11,19,20].…”

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

“…Successful eradication against Helicobacter pylori (H. pylori) had been increasingly demonstrated to recover platelet counts in patients with idiopathic thrombocytopenic purpura (ITP) [1], and reports on the long term outcome of this established treatment have been published [2][3][4]. In contrast, we had reported a reduction in platelet counts 8 weeks after the successful eradication therapy for the pathogen in non-ITP patients [5].…”

Development of corpus atrophic gastritis may be associated with Helicobacter pylori-related idiopathic thrombocytopenic purpura

“…A meta-analysis and a systematic review showed a strict correlation between H. pylori eradication and an increased platelet count [3,14]. As the long-term efficacy of H. pylori eradication treatment has been confirmed in several recent reports [22][23][24][25][26], it seems that H. pylori eradication may prove a safe and radical Many factors have been investigated to clarify the pathogenesis of H. pylori-induced thrombocytopenia. An immunological mimicry between platelet and H. pylori antigens has been discussed in several studies.…”

“…Of note, previous studies indicated that the incidence of atrophic gastritis was lower in both American whites and Canadians than in Japanese [42,43]. With regard to ITP, the platelet response rate after eradication for H. pylori-positive ITP patients was high in Japanese studies (overall rate was 58%), as well as in 2 Italian studies (56 and 74%, respectively), while the results of a Spanish, a Serbian, a Mexican, a Turkish, and 2 American studies demonstrated relatively low response rates (13,26,14,44,29, and 7%, respectively) [14]. More recently, favorable response rates were reported from Colombia and Iran (81 and 48%, respectively) [44,45].…”