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Helicobacter pylori and Idiopathic Thrombocytopenic Purpura – Where Do We Stand?
Table 1: Demographic Features of Helicobacter pylori Infection in Adult Idiopathic Thrombocytopenic Purpura Patients*
Total M/F Number of Age of Age of Plt Count of Plt Count of ITP Duration
Authors Number Ratio Infected (%) Infected (yrs) Non-infected (yrs) Infected (/µ) Non-infected (/µ) (months)
Gasbarrini et al. (1998)
4
18 5/13 11 (61) 43±14 49±12 95±39 103±24 NR
Emilia et al. (2001)
25
30 13/17 13 (43) 63±14 47±20 53±28 41±14 40 (13–120)
Jarque et al. (2001)
26
56 18/38 40 (71) 54 (17–80)
e
57±22
a
58±23 32 (2–50)
Kohda et al. (2002)
27
40 12/28 25 (62) 54±14 48±13 67±54 60±41 41±38
Hino et al. (2003)
28
30 8/22 21 (70) 55±15 51±17 38±20 22±12 NR
Hashino et al. (2003)
29
22 9/13 14 (64) 53.2±12.9 41.8±18.6 61±26 63±20 110±81
Ando et al. (2003)
30
61 12/49 50 (82) 58±11 40±16 56±24 42±24 78±65
Michel et al. (2004)
9
74 21/53 16 (22) 52.5±15.9 38.5±18.3 34
c
43
c
10.2 yrs
Takahashi et al. (2004)
15
20 5/15 15(75) 54±13 46±18 40±27 39±22 51±15
Sato et al. (2004)
31
53 16/37 39 (74) 62 (37–87)
d
52 (39–77)
d
55 (19–99)
d
56 (20–97)
d
59 (6–624)
d
Ando et al. (2004)
32
20 5/15 17 (85) 62 (38–83)
e
48 (4–86) 41 (12–82) NR
Nomura et al. (2004)
33
42 15/27 28 (66) NR NR 29±6 31±5 NR
Veneri et al. (2005)
34
43 18/25 43 (100)
g
52 (28–78)
e
NA 54±29 NA NR
Inaba et al. (2005)
24
35 11/24 25 (71) 57 (25–82)
e
52±26f 40
Stasi et al. (2005)
20
137 57/80 64 (47) 58±13 42±16 42±25 46±23 25±19
Fujimura et al. (2005)
22
435 120/315 300 (69) 59±14 47±16 NA NA 8.2±6.8 yrs
Suzuki et al. (2005)
23
36 NR 25 (69) NA NA NA NA NR
Suvajdzic et al. (2006)
35
54 12/42 39 (72) 54±13 42±16 68±32 78±32 6 (1–30) yrs
Ahn et al. (2006)
36
15 5/10 15 (100)
g
56.8±18.5 NA 72±44 NA 8.7±6.5 yrs
Sayan et al. (2006)
37
34 22/12 20 (59) 50.8±16.1 53.8±17.5 39±16 32±15 19±15
Kodama et al. (2007)
38
116 32/74 67 (58) 57.9±14.3 47.8±17.2 39±29 30±24 NA
Campuzano-Maya (2007)
39
32 7/25 29 (91) NR NR NR NR NR
Total 1403 1/2.25 916 (65)
Results are given as mean ± standard deviation, or as median (range) unless otherwise noted. * The method of detection was the 13C urea breath test. a. Values of 23 eradicated patients.
b. Median values. c. Mean (range). d. Age of all patients. e. Platelet count of all patients. f. Only patients who had tested positive for H. pylori-positive patients were investigated in this report.
NR = not reported; NA = not assessable; ITP= idiopathic thrombocytopenic purpura; Plt = platelets.
significantly enhance Fc-dependent platelet phagocytosis.
19
These results
Table 2: Results of Helicobacter pylori Eradication
suggest that infectious agents in combination with antiplatelet antibodies
could affect platelet destruction in vivo, which may be at least one
Bacterial Eradication* Platelet Response Median Follow-up
explanation of why thrombocytopenia worsens in some patients with ITP
Authors (%)
a
(%)
b
(months)
Prospective phase II studies
during infections and resolves in other patients with ITP treated with
Gasbarrini et al. (1998)
4
8/11 (73) 8 (100) 4
bacterial eradication therapy.
Emilia et al. (2001)
25
12/13 (92) 6 (50) 8.3
Jarque et al. (2001)
26
23/32 (72) 3 (13) 24
Clinical Manifestations
Kohda et al. (2002)
27
19/19 (100) 12 (63) 14.8
All prospective series that we reviewed reported no significant differences Hino et al. (2003)
28
18/21 (86) 10 (56) 15
in the clinical presentations of ITP, aside from older age, in H. pylori-
Hashino et al. (2003)
29
13/14 (93) 5 (39) 15
positive cases (see Table 1). A significant association between H. pylori
Ando et al. (2003)
30
27/29 (93) 16 (59) 11
infection and the presence of symptoms of dyspepsia has been reported
Michel et al. (2004)
9
14/16 (93) 0 (0) 11.5
Takahashi et al. (2004)
15
13/15 (87) 7 (54) 4
by Michel et al.,
9
but not by Stasi et al.
20
A cross-sectional study by Fukui
Sato et al. (2004)
31
27/32 (84) 15 (56) 6
et al. did not find any correlation between H. pylori infection and
Ando et al. (2004)
32
15/17 (88) 10 (67) 24
thrombocytopenia during pregnancy.
21
In a retrospective Japanese study,
Nomura et al. (2004)
33
12/28 (43) 15 (54)
c
NR
the H. pylori-positive positive group was significantly older (p<0.005) and Veneri et al. (2005)
34
41/43 (95) 21 (51) 31.2
had more cases of hyperplastic megakaryocytes in the bone marrow Inaba et al (2005)
24
25/25 (100) 11 (44) 6
d
(p=0.01) than patients without H. pylori infection.
22 Stasi et al. (2005)
20
52/52 (100) 11 (21) 25
Suvajdzic et al. (2006)
35
23/30 (77) 6 (26) 18 (14–32)
Ahn et al. (2006)
36
15/15 (100) 1 (7) 12
Response to Eradication Therapy
Sayan et al. (2006)
37
18/20 (90) 8 (44) 12 (4–22)
The eradication therapy used in all studies included a proton pump
Kodama et al. (2007)
38
44/52 (85) 27 (61) NR
inhibitor, clarythromycin and amoxicillin given for one week (‘triple
Campuzano-Maya (2007)
39
26/29 (90) 21 (80) 12.2
therapy’). The platelet response to such therapy is summarised in Table 2.
Total 445/513 (86) 213 (48)
In the phase III trial, Suzuki et al. evaluated the platelet count in a group Retrospective studies
of 25 H. pylori-positive chronic ITP patients who were randomised to
Fujimura et al. (2005)
22
161/207 (78) 101 (63) 12
e
receive treatment or no treatment for H. pylori infection.
23
Response to the
Phase III trials
Suzuki et al. (2005)
23
11/13 (85) 6 (55) 6
treatment was defined as complete (CR) if the platelet count was above
150x10
9
/l and partial (PR) if the platelet count increased by more than
*Eradication therapy consisted of a proton pump. inhibitor+amoxicillin/metronidazole+clarithromycin
given for 7–10 days. a. Results are expressed as the total number of patients with bacterial
50x10
9
/l six months after the eradication therapy. The investigators found eradication from among the total number of treated patients. b. Complete or partial
response among eradicated patients at the end of follow-up. c. Responses include non-
that the eradication of H. pylori infection in patients with ITP was
eradicated patients. d. Responders were followed for six months. e. Seventy-nine of 101
associated with a platelet response of 46.2% in the eradication group (4
platelet responders were followed for 12 months. NR = not reported.
EUROPEAN HAEMATOLOGY 2007 63
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