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 × 109/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 pylori–positive patients were treated and the bacteria was eradicated in 14 (93%). After 3 months, a significant response (platelet count > 50 × 109/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.

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Correlation between Helicobacter Pylori Eradication and Platelet Count in Immune Thrombocytopenic Purpura (ITP).

Blood ◽

10.1182/blood.v106.11.4003.4003 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4003-4003 ◽

Cited By ~ 2

Author(s):

Jun Ho Jang ◽

Hyeoung Il Kim ◽

Hyun Woo Lee ◽

Seok Yun Kang ◽

Joon Seong Park ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Systemic Disease ◽

Eradication Therapy ◽

Thrombocytopenic Purpura ◽

Duodenal Ulcers ◽

Autoimmune Thyroid ◽

Platelet Counts ◽

H Pylori

Abstract BACKGROUND: Helicobacter pylori has clearly been implicated in the pathogenesis of gastric and duodenal ulcers, gastritis, and gastric malignancy. Remarkably, eradication of H. pylori from the gastric mucosa has been associated with improvement of systemic disease, including Sjögren’s syndrome, rheumatoid arthritis, autoimmune thyroid disease, and immune thrombocytopenic purpura (ITP). PURPOSE: To investigate the relationship between Helicobacter pylori infection and the clinical features of idiopathic thrombocytopenic purpura (ITP), and to examine the effects of H. pylori eradication on platelet counts. METHOD: A 13C urea breath test (UBT) for H. pylori infection was performed in a 25 consecutive patients with ITP at Ajou University School of Medicine, Suwon, Korea. Patients who tested positive for H. pylori received standard eradication therapy if their platelet count was < 50 x 109/L. RESULTS: H. pylori infection was detected in 18 patients (72%) and eradication therapy was successfully administered to all infected patients. H. pylori infection was not associated with dyspepsia or other clinical or laboratory features. Platelet responses were observed in 6 (33%) of these patients, which lasted for more than 4 months in 4 patients. Platelet associated antibody and anti platelet antibody were negative to all patients. CONCLUSION: H. pylori eradication may improve the platelet counts in some of adults (33%) in whom the ITP is of recent onset.

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The Clinical Efficacy of Helicobacter pylori Eradication in Patients with Helicobacter pylori-Positive Chronic Thrombocytopenic Purpura.

Blood ◽

10.1182/blood.v106.11.4002.4002 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4002-4002 ◽

Cited By ~ 1

Author(s):

Seung-Hyun Nam ◽

Bong-Seog Kim ◽

Jae Hoon Lee ◽

Hong Suk Song ◽

Sung-Hwa Bae ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Breath Test ◽

Urea Breath Test ◽

Rapid Urease Test ◽

Thrombocytopenic Purpura ◽

Platelet Recovery ◽

Chronic Itp ◽

Urease Test ◽

H Pylori

Abstract Background: Helicobacter pylori (H pylori) has been implicated in the pathogenesis of some autoimmune diseases including idiopathic thrombocytopenic purpura (ITP). Several studies recently showed a high prevalence of H pylori infection in patients with ITP and reported a platelet recovery after bacterial eradication therapy. The prevalence of H pylori infection and effect of its eradication in Korea patients with chronic ITP were investigated. Methods: The study included among 35 patients with chronic ITP from eight hospitals. H pylori infection was assessed by urea breath test, rapid urease test or microbial culture. H pylori eradication was performed with amoxicillin, clarithromycin and omeprazol regimen for 7 days or bismuth, metronidazol and tetracycline regimen for 10 days. Eradication was assessed by urea breath test 4 weeks after treatment. Platelet counts were monitored serially after the end of treatment. Results: Thirty five patients with chronic ITP were evaluated, including 12 males and 23 females. Median age was 57 years (range 30–79). The median platelet count before eradication was 23,000/uL (range 4,000–66,000/uL). Sixteen patients were performed the splenectomy previously. H pylori infection was found in 23 (65%) of 35 patients. In 21 patients performed the eradication, 6 patients (28.5%) had a significant increase in platelet count after 2 weeks and 2 months. The response duration was 1–27 (median 7.6) months. Conclusions: This study confirmed the efficacy of H pylori eradication in increasing platelet in adult chronic ITP patients. We must consider the investigation and eradication of H pylori infection in ITP patients as a simple, inexpensive tool in management of the chronic disease.

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An Unusual Cause of Secondary ITP in a 34-Year-Old Hispanic Male

Case Reports in Hematology ◽

10.1155/2021/7965930 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Ayrton Bangolo ◽

Mohamed Ahmed ◽

Ali Atoot ◽

Ashraf Mahmoud ◽

Chibuzo Agbakwuru-Onyike ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Case Report ◽

Geographic Distribution ◽

Immune Thrombocytopenic Purpura ◽

Severe Thrombocytopenia ◽

Thrombocytopenic Purpura ◽

Platelet Counts ◽

H Pylori ◽

Hispanic Male

Secondary immune thrombocytopenic purpura (ITP) associated with Helicobacter pylori (H. pylori) infection has been described in the literature. It appears to have a geographic distribution; mostly encountered in countries with a higher prevalence for H. pylori such as Italy or Japan. H. pylori eradication has been recommended in the management of ITP with studies showing improvement in the platelet count in some patients. Substantial platelet count increases in patients with severe thrombocytopenia (platelet counts <30 × 103 microliter), however, are uncommon with H. pylori treatment alone. Here, we present a 34-year-old Hispanic male with worsening chronic thrombocytopenia that resolved following eradication of his H. pylori infection. Herein, we highlight a rare and reversible cause of secondary ITP. With this case report, we hope to encourage physicians to include H. pylori testing in the evaluation of thrombocytopenia.

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Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review

Blood ◽

10.1182/blood-2008-07-167155 ◽

2009 ◽

Vol 113 (6) ◽

pp. 1231-1240 ◽

Cited By ~ 180

Author(s):

Roberto Stasi ◽

Ameet Sarpatwari ◽

Jodi B. Segal ◽

John Osborn ◽

Maria Laura Evangelista ◽

...

Keyword(s):

Systematic Review ◽

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Response Rate ◽

Complete Response ◽

Helicobacter Pylori Infection ◽

Thrombocytopenic Purpura ◽

Overall Response ◽

H Pylori

AbstractWhether the eradication of Helicobacter pylori infection can increase the platelet count in patients with immune thrombocytopenic purpura (ITP) is still a controversial issue. To provide evidence-based guidance, we performed a systematic review of the literature published in English, selecting articles reporting 15 or more total patients. We identified 25 studies including 1555 patients, of whom 696 were evaluable for the effects of H pylori eradication on platelet count. The weighted mean complete response (platelet count ≥ 100 × 109/L) and overall response (platelet count ≥ 30 × 109/L and at least doubling of the basal count) were 42.7% (95% confidence interval [CI], 31.8%-53.9%) and 50.3% (95% CI, 41.6%-59.0%), respectively. In 222 patients with a baseline platelet count less than 30 × 109/L, the complete response rate was 20.1% (95% CI, 13.5%-26.7%) and the overall response rate was 35.2% (95% CI, 28.0%-42.4%). The response rate tended to be higher in countries with a high background prevalence of H pylori infection and in patients with milder degrees of thrombocytopenia. These findings suggest that the detection and eradication of H pylori infection should be considered in the work-up of patients with seemingly typical ITP.

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Effect of Helicobacter pylori infection on the first-line treatment outcomes in patients with immune thrombocytopenic purpura

10.22541/au.162150339.96219653/v1 ◽

2021 ◽

Author(s):

Ali Dogan ◽

Omer Ekinci ◽

Senar Ebinc

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Line Treatment ◽

First Line ◽

Thrombocytopenic Purpura ◽

Significant Difference ◽

H Pylori ◽

First Line Treatment

Background: Helicobacter pylori (H. pylori) eradication therapy is known to increase the platelet count, but in immune thrombocytopenic purpura (ITP), the effect of H. pylori infection on the response to treatment is not clear. This study aims to determine whether the response to the first–line treatment is affected by the states of H. pylori–positivity and –negativity in ITP patients. Methods: Adult newly diagnosed or chronic ITP patients who had not received eradication therapy for H. pylori infection were included. Characteristics of the patients, presence and severity of bleeding, initial platelet count, administered treatments, and treatment response rates were inspected. Results: Of 119 total patients, 32 (26.9%) were H. pylori–positive, 87 (73.1%) were H. pylori–negative. The most common treatment was standard–dose steroid in both groups (62.5% vs 68.9%, p=0.524). Rates of complete response, partial response, no response were comparable for the two groups (respectively, 75% vs 73.6%, and 18.8% vs 19.5%, and 6.2% vs 6.9%), and there was no significant difference between the groups (p=0.283). Conclusion: It can be stated according to the present study that; in ITP patients in whom treatment is indicated, the response to the first–line treatment without the administration of H. pylori eradication therapy is comparable between H. pylori–positive and H. pylori–negative patients. Keywords: Helicobacter pylori, immune thrombocytopenic purpura, first-line treatment

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Helicobacter pylori induced Immune Thrombocytopenic Purpura and perspective role of Helicobacter pylori eradication therapy for treating Immune Thrombocytopenic Purpura

AIMS Microbiology ◽

10.3934/microbiol.2021018 ◽

2021 ◽

Vol 7 (3) ◽

pp. 284-303

Author(s):

Arham Ihtesham ◽

◽

Shahzaib Maqbool ◽

Muhammad Nadeem ◽

Muhammad Bilawal Abbas Janjua ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Treatment Efficacy ◽

Molecular Mimicry ◽

Eradication Therapy ◽

Surface Antigens ◽

Thrombocytopenic Purpura ◽

Platelet Surface ◽

H Pylori

<abstract> <p>Immune thrombocytopenic purpura (ITP) is an autoimmune disease characterised by production of autoantibodies against platelet surface antigens. Recent studies have demonstrated a paramount association of ITP and <italic>Helicobacter pylori (H-pylori)</italic> infection with significant rise in platelet count following <italic>H-pylori</italic> eradication therapy. The <italic>H-pylori</italic> infection induced ITP is validated by many proposed mechanisms such as molecular mimicry due to production of autoantibodies against <italic>H-pylori</italic> surface virulent factors (CagA) and cross reactivity of these antibodies with platelet surface antigens (GP IIb/IIIa, GP Ib/IX, and GP Ia/IIa), phagocytic perturbation due to enhanced phagocytic activity of monocytes, enhanced dendritic cell numbers and response, platelets aggregation due to presence of anti- <italic>H-pylori</italic> IgG and von Willebrand factor (vWf) and finally host immune response against <italic>H-pylori</italic> virulent factors CagA and VacA leading to ITP. The effectiveness of <italic>H-pylori</italic> eradication therapy has also been demonstrated with platelet count being used as a predictive factor for assessment of treatment efficacy. Out of 201 patients 118 were responding to the triple therapy and remaining 83 patients were non-responders, showing the response rate of 58.7%. Out of 118 responders 69 patients were showing complete response (CR) and 49 were showing partial response (PR) to the <italic>H-pylori</italic> eradication therapy. However, more studies are required to elucidate this association and treatment efficacy.</p> </abstract>

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Does Helicobacter pylori Eradication Therapy Result in a Platelet Count Improvement in Adults with Immune Thrombocytopenic Purpura Regardless of H pylori Infection?

Hematology ◽

10.1182/asheducation-2008.1.31 ◽

2008 ◽

Vol 2008 (1) ◽

pp. 31-32 ◽

Cited By ~ 7

Author(s):

Donald M. Arnold ◽

Roberto Stasi

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Thrombocytopenic Purpura ◽

Helicobacter Pylori Eradication ◽

History Of ◽

H Pylori ◽

Helicobacter Pylori Eradication Therapy ◽

Therapy Result

AbstractA 34-year-old male with a long history of immune thrombocytopenic purpura (ITP) presents to your office. His platelet count is 30 × 109/L and he is clinically stable with no bleeding symptoms. He has read that Helicobacter pylori eradication therapy may be effective for ITP and he asks you about this. You do not have access to reliable tests for H pylori infection (e.g., urea breath test), yet you wonder about the benefit of empiric eradication therapy for your patient.

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

Blood ◽

10.1182/blood-2006-12-063222 ◽

2007 ◽

Vol 110 (12) ◽

pp. 3833-3841 ◽

Cited By ~ 47

Author(s):

Giovanni Emilia ◽

Mario Luppi ◽

Patrizia Zucchini ◽

Monica Morselli ◽

Leonardo Potenza ◽

...

Keyword(s):

Helicobacter Pylori ◽

Chronic Gastritis ◽

Immune Thrombocytopenic Purpura ◽

Long Term Results ◽

Platelet Response ◽

Related Factors ◽

Thrombocytopenic Purpura ◽

Platelet Recovery ◽

Chronic Immune Thrombocytopenic Purpura ◽

H Pylori

AbstractEradication of Helicobacter pylori may lead to improvement of chronic immune thrombocytopenic purpura (ITP), although its efficacy over time is uncertain. We report the results of H pylori screening and eradication in 75 consecutive adult patients with ITP. We also used molecular methods to investigate lymphocyte clonality and H pylori genotypes in the gastric biopsies from 10 H pylori–positive patients with ITP and 19 H pylori–positive patients without ITP with chronic gastritis. Active H pylori infection was documented in 38 (51%) patients and successfully eradicated in 34 (89%) patients. After a median follow-up of 60 months, a persistent platelet response in 23 (68%) of patients with eradicated infection was observed; 1 relapse occurred. No differences in mucosal B- or T-cell clonalities were observed between patients with ITP and control participants. Of note, the frequency of the H pylori cagA gene (P = .02) and the frequency of concomitant H pylori cagA, vacAs1, and iceA genes (triple-positive strains; P = .015) resulted statistically higher in patients with ITP than in control participants. All asymptomatic H pylori–positive patients with ITP were suffering from chronic gastritis. Our data suggest a sustained platelet recovery in a proportion of patients with ITP by H pylori eradication alone. Overrepresentation of specific H pylori genotypes in ITP suggests a possible role for bacterium-related factors in the disease pathogenesis.

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INFLAMMATORY DISORDERS ASSOCIATED WITH HELICOBACTER PYLORI IN THE ROUX-EN-Y BYPASS GASTRIC POUCH

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201600s10009 ◽

2016 ◽

Vol 29 (suppl 1) ◽

pp. 31-34 ◽

Cited By ~ 2

Author(s):

Luiz Claudio Lopes CHAVES ◽

Isabela Klautau Leite Chaves BORGES ◽

Maíra Danielle Gomes de SOUZA ◽

Ian Passos SILVA ◽

Lyz Bezerra SILVA ◽

...

Keyword(s):

Bariatric Surgery ◽

Helicobacter Pylori ◽

Gastric Pouch ◽

Obese Patients ◽

Inflammatory Lesions ◽

Low Incidence ◽

H Pylori ◽

A Prospective Study ◽

Grade Iii

ABSTRACT Background: The prevalence of Helicobacter pylori in obese candidates for bariatric surgery and its role in the emergence of inflammatory lesions after surgery has not been well established. Aim: To identify the incidence of inflammatory lesions in the stomach after bariatric surgery and to correlate it with H. pylori infection. Methods: This is a prospective study with 216 patients undergoing Roux-en-Y gastric bypass. These patients underwent histopathological endoscopy to detect H. pylori prior to surgery. Positive cases were treated with antibiotics and a proton inhibitor pump followed by endoscopic follow-up in the 6th and 12th month after surgery. Results: Most patients were female (68.1%), with grade III obesity (92.4%). Preoperative endoscopy revealed gastritis in 96.8%, with H. pylori infection in 40.7% (88/216). A biopsy was carried out in 151 patients, revealing H. pylori in 60/151, related to signs of inflammation in 90% (54/60). In the 6th and 12th month after surgery, the endoscopy and the histopathological exam showed a normal gastric pouch in 84% of patients and the incidence of H. pylori was 11% and 16%, respectively. The presence of inflammation was related to H. pylori infection (p<0,001). Conclusion: H. pylori has a similar prevalence in both obese patients scheduled to undergo bariatric surgery and the general population. There is a low incidence of it in the 6th and 12th months after surgery, probably owing to its eradication when detected prior to surgery. When inflammatory disease is present in the new gastric reservoir it is directly related to H. pylori infection.

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Efficacy of Helicobacter pylori Eradication Therapy on Platelet Recovery in Pediatric Immune Thrombocytopenic Purpura-Case Series and a Systematic Review

Microorganisms ◽

10.3390/microorganisms8101457 ◽

2020 ◽

Vol 8 (10) ◽

pp. 1457

Author(s):

Tamaki Ikuse ◽

Masanori Toda ◽

Kosuke Kashiwagi ◽

Kimiko Maruyama ◽

Masumi Nagata ◽

...

Keyword(s):

Systematic Review ◽

Helicobacter Pylori ◽

Immune Thrombocytopenic Purpura ◽

Pediatric Patients ◽

Eradication Therapy ◽

Platelet Response ◽

Thrombocytopenic Purpura ◽

Helicobacter Pylori Eradication ◽

H Pylori ◽

Helicobacter Pylori Eradication Therapy

Evidence relating to the efficacy of Helicobacter pylori eradication therapy for chronic immune thrombocytopenic purpura (cITP) in childhood is inadequate. The aim of this retrospective study was to determine the efficacy of H. pylori eradication therapy for platelet response in pediatric patients with cITP in our hospital, and to perform a systematic review of previous reports about pediatric patients with cITP who were positive for H. pylori infection and were treated with H. pylori eradication therapy. Analysis of the data of pediatric patients with cITP in our hospital and a systematic review of digital literature databases of studies in pediatric patients with cITP were performed. Data of 33 pediatric patients with cITP from our hospital records showed that the prevalence of H. pylori infection and the rate of response to platelet therapy were 15% and 33.3%, respectively. Data of 706 pediatric patients from 18 previous reports showed that the prevalence of H. pylori infection and rate of platelet response were 23% and 43.8%, respectively. Eradication therapy for H. pylori infection in pediatric cITP patients can be expected to result in a response equivalent to that in the adult population, with fewer adverse effects than other treatments for cITP.

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