Haematologica, Vol 94, Issue 6, 850-856 doi:10.3324/haematol.2008.005348
Copyright © 2009 by Ferrata Storti Foundation
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Decision Making and Problem Solving

Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review

Donald M. Arnold1, Ashley Bernotas1, Ishac Nazi2, Roberto Stasi3, Masataka Kuwana4, Yang Liu1, John G. Kelton1,2, Mark A. Crowther1

1 Michael G. DeGroote School of Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
2 Michael G. DeGroote School of Medicine, Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
3 Department of Medical Sciences, Ospedale "Regina Apostolorum", Albano Laziale, Italy
4 Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan

Correspondence: Donald M. Arnold MD, MSc, FRCP(C), HSC 3V-48, 1200 Main Street West, Hamilton, Ontario, Canada. E-mail:arnold{at}mcmaster.ca

ABSTRACT

Eradication of H. pylori improves thrombocytopenia in some patients with immune thrombocytopenic purpura by mechanisms that remain obscure. Platelet count responses may occur independently of H. pylori infection as a result of the immune modulating effects of macrolide antimicrobials or the removal of other commensal bacteria. We performed a systematic review of the literature to determine the effect of H. pylori eradication therapy in patients with immune thrombocytopenic purpura by comparing the platelet response in patients who were, and who were not infected with H. pylori. MEDLINE, EMBASE, Cochrane central registry and abstracts from the American Society of Hematology (from 2003) were searched in duplicate and independently without language or age restrictions. Eleven studies, 8 from Japan, were included enrolling 282 patients with immune thrombocytopenic purpura who received eradication therapy; 205 were H. pylori-positive and 77 were H. pylori-negative. The odds of achieving a platelet count response following eradication therapy were 14.5 higher (95% confidence interval 4.2 to 83.0) in patients with H. pylori infection (51.2% vs. 8.8%). No study reported bleeding or quality of life. Adverse events were reported in 12 patients. H. pylori eradication therapy was of little benefit for H. pylori-negative patients. These findings strengthen the causal association between H. pylori infection and immune thrombocytopenia in some patients. Randomized trials are needed to determine the applicability of H. pylori eradication therapy across diverse geographical regions.

Key words: helicobacter, autoimmunity, purpura, platelets.


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J. N. George
Definition, diagnosis and treatment of immune thrombocytopenic purpura
Haematologica, June 1, 2009; 94(6): 759 - 762.
[Full Text] [PDF]