Eradication of Infection Improves Outcomes for H Pylori+ patients with ITP

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Gram-negative <i>H pylori</i> infection is responsible for many ITP cases.
Gram-negative H pylori infection is responsible for many ITP cases.

Approximately 40% of idiopathic thrombocytopenic purpura (ITP) cases are caused by infection with gram-negative Helicobacter pylori according to a recent study published in Gastroenterology Research and Practice.

Idiopathic thrombocytopenic purpura is an autoimmune bleeding disorder in which the body destroys native platelets, resulting in low platelet count and easy bruising and bleeding. H pylori infection is associated with ITP as well as other common autoimmune diseases such as anemia, rheumatoid arthritis and sicca syndrome. However, while eradication of H pylori infection has shown promise as a treatment for other diseases there are conflicting reports about its effectiveness in restoring platelet count in patients with ITP.

Researchers analyzed the stool and bone marrow samples of 85 patients, 32 male and 53 female, with ITP for evidence of H pylori infection. A total of 34 patients (40%), were infected with H pylori. Next the researchers investigated the effectiveness of standard H pylori eradication in restoring platelet count. To eradicate H pylori patients took amoxicillin 1 g twice daily, clarithromycin 500 mg twice daily, and a proton pump inhibitor 40 mg twice daily for 2 weeks.

In patients infected with H pylori, mean platelet count improved from 48.56 million/μL to 94.2 million/μL. No change in platelet count was observed in response to H pylori eradication treatment in uninfected ITP patients. Among the 34 infected patients, 19 (55.8%) achieved complete response, 10 (29.9%) achieved partial response, and 5 (14.7%) achieved no response to the eradication treatment. 

The authors conclude that, “40% of the local cITP patients are H pylori infected and that H pylori eradication therapy in these individuals significantly improves the platelet counts. Further studies on a larger cohort of patients, with a longer follow-up, will allow a better insight into the true prevalence of H pylori infection and the duration of remission. Such studies will also conceivably endorse clarity of actual prevalence and understanding of mechanisms underlying the response to eradication therapy.”

Reference

1. Sheema K, Ikramdin U, Arshi N, et al. Role of Helicobacter pylori eradication therapy on platelet recovery in chronic immune thrombocytopenic purpura [published online January 17, 2017]. Gastroenterol Res Pract. doi: 10.1155/2017/9529752

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