PLATELET COUNT RESPONSE TO HELICOBACTER PYLORI ERADICATION IN IRANIAN ‎PATIENTS WITH IDIOPATHIC THROMBOCYTOPENIC ‎PURPURA

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune hematological disordercharacterized by auto antibody-mediated platelet destruction. Although the main cause of ITPremains unclear, but its relationship with some infection was demonstrated. In recent years, many studies have demonstrated improvement of platelet counts in ITP patients after treating Helicobacter pylori infection. The aim of this study was to investigate the effects of H. pylori eradication on platelet count response in Iranian ITP patients.A total of 26 patients diagnosed with both ITP and H. pylori infection. ITP were diagnosed whose platelet counts were less than 100×103/μL. These patients were tested for H. pylori infection by Urea Breath Test and serum H. pylori antibody. All patients received triple therapy for 7 or 14 days to eradicate H. pylori infection. These patients followed for six months.Prevalence of H. pylori was 67.3%. H. pylori eradication achieved in 89.5% (26/29). Of the 26 patients, 15 (57.7%) exhibited a complete response (CR) and 11 (42.3%) were unresponsive. We did not find partial responders. There was a significant difference in the baseline platelet count of responders and non-responders patients (p<0.001). All responders had platelet count ≥50×103/μLand all non-responders had platelet count <50×103/μL.Results of this study revealed that eradication therapy of H. pylori infection can improve platelet counts in ITP patients especially with mild thrombocytopenia and support routine detection andtreatment of H. pylori infection in ITP patients in populations with a high prevalence of this infection.

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Clinical Features and Effects of Eradication on Helicobacter Pylori Positive 207 ITP Cases in Japan.

Blood ◽

10.1182/blood.v104.11.2071.2071 ◽

2004 ◽

Vol 104 (11) ◽

pp. 2071-2071

Author(s):

Kingo Fujimura ◽

Masataka Kuwana ◽

Yoshiyuki Kurata ◽

Masahiro Imamura ◽

Hiroshi Harada ◽

...

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Eradication Therapy ◽

The Other ◽

First Line ◽

Platelet Counts ◽

Count Response ◽

Successful Group ◽

H Pylori ◽

Over 40 Years

Abstract In 1998, Gasbarrini et al reported that in ITP cases with Helicobacter pylori (H.pylori) infection, elevation of platelet counts was observed by eradication of this bacterium. Since then, several reports from Italy and Japan confirmed the elevation of platelet counts after eradication. However, the characteristic background in the H.pylori positive ITP and eradication effects on platelet counts is unclear. On the other hand, reports from Spain, North Europe and USA could not show the evidence that eradication is effective on elevating platelet counts in H.pylori positive ITP. Therefore, we designed a nationwide retrospective study in Japan to evaluate the incidence of H.pylori positive ITP cases and the effects of eradication on platelet counts and to clear above problems. Four hundred and thirty-five ITP cases were enrolled over a period of one and half years (2002. 7~2003.12) from 12 hospitals. H. pylori infection was found in 300 cases(65%), who were significantly (P<0.005) older and showed hyperplastic megakaryocyte in bone marrow (P=0.011) comparison with negative cases. Eradication to H. pylori was performed in 207 H. pylori positive ITP cases and as a whole, the platelet count response was observed in 63% of eradication succeeded group. In the successful group, CR and PR rate were 23% and 42% respectively at 12 months after eradication. The platelet count response was significant in the successfully eradicated group (P<0.005) and the increased platelet count was maintained without ITP treatment for over 12 months. In conclusion, H. pylori infection was involved in most ITP patients over 40 years old in Japan and eradication therapy proved effective for increasing platelet counts even in splenectomy non-responsive cases and the platelet count response appeared one month after eradication. This evidence suggests that eradication therapy is the first line of treatment in H. pylori positive ITP patients.

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Impact of Helicobacter pylori Eradication Therapy on Platelet Counts in Patients With Chronic Idiopathic Thrombocytopenic Purpura

Global Journal of Health Science ◽

10.5539/gjhs.v8n7p35 ◽

2015 ◽

Vol 8 (7) ◽

pp. 35 ◽

Cited By ~ 2

Author(s):

Mohamadreza Amiri

Keyword(s):

Helicobacter Pylori ◽

Platelet Count ◽

Eradication Therapy ◽

Current Treatment ◽

Thrombocytopenic Purpura ◽

Stool Antigen Test ◽

Platelet Counts ◽

Before And After ◽

History Of ◽

H Pylori

This study was a before and after clinical evaluation of Helicobacter pylori eradication on platelet counts in a group of 23 patients with chronic Idiopathic (Autoimmune) thrombocytopenic purpura (CITP). H. pylori infection was identified in patients by a 13C-urea breath test and confirmed by an H. pylori stool antigen test. Eradication was conducted in patients testing positive. Infected (n = 10) and uninfected (n = 13) patient groups did not differ with respect to age, gender, history of previous splenectomy, treatment with anti-D, current treatment with corticosteroids, or initial platelet counts. H pylori eradication was successful in eight infected CITP patients, with two patients not responsive to treatment. Compared to the uninfected group, patients in the infected group who responded to eradication therapy had significantly increased platelet counts after six months (56.2 ± 22.2 vs. 233 ± 85.6 ×103 million cells/L; P < 0.01), whereas platelet counts in the non-responding patients and uninfected group did not differ after this period of time. H. pylori eradication promotes significant platelet count improvement in patients with CITP. Thus, all patients with CITP should be tested and treated for H. pylori infections.

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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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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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Impact of eradication therapy of Helicobacter pylori in children with chronic immune thrombocytopenic purpura

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-021-00053-3 ◽

2021 ◽

Vol 69 (1) ◽

Author(s):

Mahmoud M. Hodeib ◽

Ahmed G. Ali ◽

Nsreen M. Kamel ◽

Shaimaa A. Senosy ◽

Ehab M. Fahmy ◽

...

Keyword(s):

Platelet Count ◽

Pediatric Patients ◽

Eradication Therapy ◽

Thrombocytopenic Purpura ◽

Chronic Itp ◽

Count Response ◽

Significant Difference ◽

Stool Antigen ◽

H Pylori ◽

The Impact

Abstract Background Although some investigators have confirmed the association between H. pylori and chronic ITP in adults, studies in pediatric patients are still few and have produced conflicting results. The study was carried out to detect the prevalence of H. pylori among chronic ITP children and to investigate the impact of treatment of H. pylori infection on platelet count response. Results The prevalence of H. pylori in chronic ITP children was 63%. The platelet count was statistically significantly higher among H. pylori stool antigen (HpSA)-negative children. A significant difference was reported in which platelet count increased from 70.55 ± 4.788 million/μL before H. pylori eradication therapy to 110.78 ± 15.128 million/μL after therapy. Conclusion We concluded that H. pylori eradication therapy was effective in increasing platelet count in H. pylori-positive chronic ITP patients.

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Role of Helicobacter pylori Eradication Therapy on Platelet Recovery in Chronic Immune Thrombocytopenic Purpura

Gastroenterology Research and Practice ◽

10.1155/2017/9529752 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Khan Sheema ◽

Ujjan Ikramdin ◽

Naz Arshi ◽

Naz Farah ◽

Sheikh Imran

Keyword(s):

Bone Marrow ◽

Helicobacter Pylori ◽

Immune Thrombocytopenic Purpura ◽

Eradication Therapy ◽

Bone Marrow Examination ◽

Thrombocytopenic Purpura ◽

Platelet Counts ◽

Chronic Immune Thrombocytopenic Purpura ◽

Chronic Itp ◽

H Pylori

Background. Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder in which the immune system destroys native platelets. In this condition an autoantibody is generated against a platelet antigen. ITP affects women more often than men and is more common in children than adults. Objective. To assess the effect of Helicobacter pylori eradication therapy (HPET) on platelet count in Helicobacter pylori associated chronic immune thrombocytopenic purpura (chronic ITP) in adult. Materials and Methods. It is an interventional prospective study conducted at Liaquat University of Medical and Health Sciences, Jamshoro, from 2014 to 2015. A set of 85 patients diagnosed with chronic ITP were included in the study via convenient sampling. Patients with platelets count < 100 × 109/L for >3 months were selected. They were posed to first-line investigations which comprised complete blood count (CBC) and peripheral blood smear examination followed by second-line tests including bone marrow examination and Helicobacter pylori stool specific antigen (HpSA-EIA). Standard H. pylori eradication therapy was offered and the patients were assessed at regular intervals for 6 months. Results. Of the 85 study patients, 32 (37.6%) were male and 53 (62.3%) were female. Mean ages of H. pylori positive and negative subjects were 43.89 ± 7.06 and 44.75 ± 7.91 years, respectively. Bone marrow examination confirmed the diagnosis and excluded other related BM disorders. H. pylori stool antigen (HpSA) was detected in 34 (40%) patients and hence regarded as H. pylori positive; the rest were negative. Treatment with eradication therapy significantly improved the mean platelet counts from 48.56±21.7 × 109/l to 94.2±26.8 × 109/l. Conclusion. We concluded that the anti-H. pylori eradication therapy improves blood platelet counts in chronic immune thrombocytopenia.

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Prevalence and clinical significance of elevated antiphospholipid antibodies in patients with idiopathic thrombocytopenic purpura

Blood ◽

10.1182/blood.v84.12.4203.bloodjournal84124203 ◽

1994 ◽

Vol 84 (12) ◽

pp. 4203-4208 ◽

Cited By ~ 113

Author(s):

R Stasi ◽

E Stipa ◽

M Masi ◽

F Oliva ◽

A Sciarra ◽

...

Keyword(s):

Platelet Count ◽

Clinical Features ◽

Idiopathic Thrombocytopenic Purpura ◽

Solid Phase ◽

Oral Prednisone ◽

Complete Response ◽

Anticardiolipin Antibodies ◽

Common Finding ◽

Thrombocytopenic Purpura ◽

Significant Difference

Antibodies against phospholipid antigens (APA) have been demonstrated in idiopathic thrombocytopenic purpura (ITP), but their clinical and pathogenetic significance has remained elusive. In this study we analyzed the prevalence and clinical features of ITP patients with elevated APA. In addition, we prospectively evaluated APA levels after treatment with corticosteroids and compared them with platelet- associated immunoglobulin (PAIgG) titers. We studied 149 patients with newly diagnosed ITP. Of these, 78 had a platelet count less than 50 x 10(9)/L and received an initial treatment with oral prednisone (PDN). In 71 asymptomatic cases with platelet counts between 50 x 10(9)/L and 120 x 10(9)/L, no therapy was scheduled. However, in five of them, the platelet count fell below 50 x 10(9)/L after more than 12 months; these patients were treated with PDN. Tests for APA included the measurement of anticardiolipin antibodies (ACA) with a solid-phase immunoassay and the detection of the lupus-like anticoagulant (LA) activity with coagulation tests that included kaolin-clotting time, dilute Russel's Viper venom time, activated partial thromboplastin time (aPTT), and dilute aPTT. Controls consisted of 174 apparently healthy subjects. Either LA or elevated ACA was seen in 69 patients (46.3%) at diagnosis. LA and ACA were both elevated in 24 cases (16.1% of the overall patient population and 34.8% of patients with high APA concentrations). No correlation was found between LA ratio values and ACA-IgG or -IgM titers, or between ACA-IgG and ACA-IgM levels. The presence of these antibodies was not associated with sex, age, platelet count, or the severity of hemorrhages. PAIgG was detected in 106 of 127 cases (83%). Again, no relationship was observed with clinical parameters or with APA levels. However, all cases with elevated APA also had increased PAIgG. With regard to the clinical course, we were not able to detect any significant difference between patients with normal and elevated APA. An initial complete response to prednisone treatment was observed in 43 of 83 cases (51.8%), with 13 (15.7%) achieving a prolonged complete remission. APA levels were not significantly modified after PDN therapy and on relapse. We conclude that APA positivity is a common finding in patients with ITP and does not select a category with different clinical features. APA levels are not influenced by immunosuppressive therapy with steroids and are not related to the activity of the disease. Therefore, we do not support a role for APA in the pathogenesis of ITP.

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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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The Efficacy of H. pylori Eradication Therapy in H. pylori-Infected and Uninfected Patients with Immune Thrombocytopenic Purpura: A Systematic Review.

Blood ◽

10.1182/blood.v112.11.3413.3413 ◽

2008 ◽

Vol 112 (11) ◽

pp. 3413-3413

Author(s):

Donald M. Arnold ◽

Ashley Bernotas ◽

Ishac Nazi ◽

Roberto Stasi ◽

Masataka Kuwana ◽

...

Keyword(s):

Systematic Review ◽

Platelet Count ◽

Immune Thrombocytopenic Purpura ◽

Immune Modulation ◽

Eradication Therapy ◽

Independent Effect ◽

Thrombocytopenic Purpura ◽

Count Response ◽

Central Registry ◽

H Pylori

Abstract Introduction: Helicobacter pylori eradication therapy results in the improvement of thrombocytopenia in up to 60% of patients with chronic immune thrombocytopenic purpura (ITP). Whether this effect is directly linked to H. pylori eradication, or to other effects of the treatment such as immune modulation or the eradication of other commensal bacteria, remains uncertain. We performed a systematic review of the literature to determine the independent effect of H. pylori eradication therapy on the platelet count in ITP by comparing its efficacy in H. pylori-infected and uninfected patients. Methods: All studies examining the platelet response following H. pylori eradication therapy in patient with ITP who were, and who were not, infected with H. pylori were included. No language or age restrictions were applied. Article selection, data abstraction and assessment of study quality were performed in duplicate. We searched MEDLINE, EMBASE, Cochrane central registry, abstracts from the American Society of Hematology (from 2003), canvassed experts and hand searched bibliographies of relevant articles. Results: The initial search yielded 265 citations of which 101 were excluded after screening for relevance, and an additional 154 were excluded because they did not meet eligibility criteria. Ten studies (8 from Japan), were included. In total, 333 patients were enrolled, 68.2% female, mean (+/− SD) age 51.6 +/− 17 years. Mean baseline platelet count was 42 +/− 26 x109/L, mean prior duration of ITP was 30.7 +/− 49 months, and 38 patients (11.4%) had undergone splenectomy. H. Pylori infection was confirmed by the urea breath test, and eradication therapy consisted of amoxicillin 750 – 1500mg twice daily, clarithromycin 200 – 400mg twice daily, and a proton pump inhibitor for 7 days in most studies. We identified 201 H. pylori-positive and 59 H. pylori-negative patients treated with eradication therapy. Eradication was achieved in 164 (94.3%) H. pylori infected patients. The overall platelet count response (variably defined) following eradication therapy for H. pylori-positive, eradicated, and negative patients was 52.7%, 54.3% and 3.4%, respectively (p <0.0001 for eradicated vs. negative). Similarly, pooling the results of only those studies employing a homogeneous response criteria (platelet count increase to 40 x109/L or higher at 3 – 6 months), the overall response for H. pylori-positive (n=121), eradicated (n=116), and negative (n=39) patients was 50.4%, 51.7% and 5.1% respectively (p<0.0001). Of the 10 reported patients with non-eradicated H. pylori infection, 2 achieved a platelet count response following eradication therapy. Mean time to response was 2.4 weeks, and mean duration of response was 15.7 months. Mild adverse events were reported in 12 patients. Conclusion: Our findings suggest that the benefit derived from H. pylori eradication therapy on platelet count response in patients with ITP is mostly due to H. pylori eradication, and not to the treatment itself. Eradication therapy should be offered only to those patients with confirmed H. pylori infection. Randomized trials in consecutive ITP patients are needed to confirm this observation.

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