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Infection in Haematology
CR and 2 PR) and 0% in the non-eradication group (p<0.01). The platelet immunoglobulins and the H. pylori CagA protein. The data indicate that
response was also significantly more common in patients with infection eradication of H. pylori is accompanied by a platelet response in
sustained by CagA-positive strains of H. pylori (p=0.04). approximately half of ITP adult patients, with ample variations in the
response rate among the various series. The chances of response appear
The overall response of the 17 phase II trials was 58%, ranging from 0% high in the Italian and Japanese series and poor in the series from other
in the American series
9
to 100% in the early Italian series.
4
Two of these countries. Bacterial factors (i.e. the variability of H. pylori strains) may
trials had an internal control. In the Italian–English study, eradication account for these findings. Eradication therapy has a favourable toxicity
therapy was administered to H. pylori-positive patients who either had a profile compared with standard ITP therapy.
platelet count <50x10
9
/l or had symptoms of dyspepsia.
20
Platelet
responses were observed in 17/52 patients (33%)who received Should patients with ITP be routinely screened for H. pylori?
treatment and 0/12 patients (0%) who did not. Inaba et al. administered Considering the low costs, non-invasiveness of diagnostic methods and
one week of triple therapy to 35 patients with chronic ITP.
24
A platelet the favourable toxicity profile of eradication therapy compared with
response was observed in 11 of the 25 patients (44%) cured of H. pylori standard ITP therapy, the detection and eradication of H. pylori
infection and in none of the 10 H. pylori-negative patients (p=0.015). In infection should be considered in those populations with a high
the retrospective study by Fujimara et al., the platelet count response prevalence of H. pylori infection.
was observed in 63% of the successful eradication group.
22
Collectively,
none of the ITP patients who were not eradicated of their H. pylori What diagnostic tests for H. pylori infection are preferable? Serological
infection after triple therapy achieved a platelet response. Adverse tests are very sensitive but not specific indicators of an active infection
events from eradication therapy have been described as mild, usually and are not useful for monitoring H. pylori eradication. Very sensitive,
consisting of abdominal pain and diarrhoea, and lead to discontinuation non-invasive diagnostic methods include the antigen stool test and the
of treatment in fewer than 5% of cases. 13C urea breath test.
1
The 13C urea breath test has been recommended
as a clinical gold standard against which other diagnostic methods can be
Conclusions validated. A comparison of antibodies to H. pylori-associated antigens in
The data so far reported indicate that the prevalence of H. pylori infection platelet eluates from ITP patients in countries with different rates of
in ITP mirrors the prevalence of H. pylori infection in the general H. pylori and different responses to eradication therapy is one possible
population. Although the pathogenesis of ITP associated with H. pylori is area of research. The diagnosis and treatment of H. pylori infection in all
still not well defined, recent evidence suggests a plausible pathogenetic patients with newly diagnosed ITP before autonomous B-cell clones have
mechanism involving cross-reactivity between platelet-associated developed is another. ■
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64 EUROPEAN HAEMATOLOGY 2007
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