Idiopathic thrombocytopenia and H pylori infection

In 1998, Akiyama and Onozawa [54] demonstrated that a PPI administration was associated with an increase in platelet count in patients with chronic idiopathic thrombocytopenia (ITP). Subsequently, a Lancet paper in a pilot study by Gasbarini et al. [55] described a significant increase in platelet count in 8 of 11 patients with H. pylori, which was successfully eradicated. Since then, there have been numerous case reports and case series reporting that eradication of H. pylori is accompanied by platelet increase in adults patients with ITP. A review by Franchini and Vener [56]i summarized the adult literature. Of a total of 1126 patients with ITP, 64% were infected with H. pylori, eradication occurred in 81% with the platelet response rate occurring in approximately 50%. Subsequently, there has been a randomized control trial looking at the effect of H. pylori eradication in adult patients with chronic ITP involving 36 Japanese patients, 25 of whom were positive for H. pylori; 13 of these 25 were randomized to the eradication group and 12 to the non-eradication group. Of the 13 patients in the eradication group, 6 had either partial or complete response in their platelet count, whereas none of the patients in the non-eradicated group responded [57]. In another small randomized control trial there was no difference when comparing PPI versus H. pylori eradication therapy in the treatment of ITP [58]. The potential explanation for this is likely molecular mimicry, where anti-platelet antibodies in the serum recognize the CAG protein of H. pylori [59].

The data are conflicting for children [60, 61]. There are a number of case reports of children with ITP and increased platelet count following H. pylori eradication [62-64]. Most of these reports came from the Far East. Other reports demonstrated no association between these two conditions [65]. These reports suggest that much larger randomized placebo-controlled trials need to be performed in children from different ethic backgrounds to determine whether in fact there is an association between the two conditions. This study needs to be conducted in areas with both low and high prevalence of H. pylori infection.

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