Korean J Hematol.  2010 Jun;45(2):127-132. 10.5045/kjh.2010.45.2.127.

Effects of Helicobacter pylori eradication in patients with immune thrombocytopenic purpura

• Tag HS
• Lee HS
• Jung SH
• Kim BK
• Kim SB
• Lee A
• Lee JS
• Shin SH
• Kim YS

• KMID: 2083546
• DOI: http://doi.org/10.5045/kjh.2010.45.2.127

Abstract

BACKGROUND
The relationship between Helicobacter pylori (H. pylori) infection and chronic idiopathic thrombocytopenic purpura (ITP) has been confirmed; however, no clear evidence for the effectiveness of H. pylori eradication on ITP exists thus far. The purpose of this study was to investigate platelet recovery in chronic ITP after H. pylori eradication.
METHODS
A total of 25 patients (18 male, 7 female; the median age of 55 years) diagnosed with ITP, whose platelet counts were less than 100x10(3)/microliter, were enrolled. They were tested for H. pylori infection by the rapid urea test or urea breath test. All patients received triple therapy for 7 or 14 days to eradicate H. pylori infection.
RESULTS
Of the 25 patients, 23 (92%) were diagnosed with H. pylori infection. Of all the ITP patients, 11 (44%) exhibited a complete response (CR) to H. pylori eradication therapy; 6 (24%), a partial response (PR); and 8 (32%) were nonresponsive (NR). Predictive factors of response after H. pylori eradication therapy were platelet counts at the initial response (27.3% responders among patients with platelet counts <100x10(3)/microliter vs 100% responders among patients with platelet counts > or =100x10(3)/microliter, P<0.001) and H. pylori infectivity (73.9% responders among the H. pylori positive patients vs 0% responders among the H. pylori negative patients, P=0.032).
CONCLUSION
This study confirmed the efficacy of H. pylori eradication in increasing the platelet count in ITP patients. Further studies with a larger number of patients are necessary to identify the crucial predictive factors responsible for platelet recovery in chronic ITP patients with the H. pylori infection.

Keyword

Helicobacter pylori; Idiopathic thrombocytopenic purpura; Platelet counts

MeSH Terms

Blood Platelets
Breath Tests
Helicobacter
Helicobacter pylori
Humans
Male
Platelet Count
Purpura, Thrombocytopenic, Idiopathic
Urea
Urea

Figure

• 

  Fig. 1 Response duration after Helicobacter pylori eradication therapy in patients with idiopathic thrombocytopenic purpura (ITP). The median duration from response to relapse of ITP was 27.43 months (range, 2.0-116.9 months).

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  Fig. 2 Individual changes of platelet counts in responsive, non-responsive and relapsed patients with complete Helicobacter pylori (H. pylori) eradication were shown. Time course of platelet counts after H. pylori eradication therapy in responsive patients (A), non-responsive patients (B), and relapsed patients (C). In Fig. 1(C), 1 patient relapsed at 2 months after H. pylori eradication therapy and then platelet counts recovered after treatment with rituximab.

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