Characteristics of Helicobacter pylori‐Induced Gastritis and the Effect of H. pylori Eradication in Patients with Chronic Idiopathic Thrombocytopenic Purpura

Abstract

H. pylori-infected ITP patients have a corpus-predominant pattern of gastritis but the virulence profile of their strains does not differ from that of ulcer or NUD patients. Eradication of H. pylori infection is a good therapeutic option for some patients with chronic ITP, especially for those who develop ITP in older age.

Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles

“…Platelet recovery was found in patients previously refractory to immunosuppression or splenectomy, as reported by others. 7,40 We also observed a response rate of 71% in patients with a severe form of ITP (platelets Ͻ 30 ϫ 10 9 /L), similar to that of other reports, 7,40 whereas minor 41 or nearly negative 10 results were also reported.…”

“…infection in our series is not higher than that (58%) in the general population of the area of Modena province, 36 or that (67%) in healthy Italian blood donors aged 50 years or older, 37 in keeping with the data from the other countries, where the prevalence of infection in patients with ITP is similar or lower than that of the general population of the same area, 6,10,13,38,39 with rare exceptions. 15,40 In our study, we observed a platelet improvement in 68% of patients with eradicated infection (60.5% of patients infected; 30.6% of total patients with ITP); in about 1500 patients so far reported in the literature, including the 3 US and Spanish cohorts with the lowest responses, the rate of response was about 53%. 17 The highest response rate was reported in cohorts from Italy, Japan, and the United Kingdom.…”

“…A similar finding, but in dyspeptic patients with ITP, has only been reported by another group. 40 Finally, at the end of follow-up, our living patients are all in remission, without any treatment; only 1 patient relapsed, and 2 died from non-ITP-related disease. The follow-up of 60 months in our study is the longest reported so far, whereas in the literature, it varies from 4 to 24 months, except for 1 series followed for 31.2 months.…”

“…17 The highest response rate was reported in cohorts from Italy, Japan, and the United Kingdom. A better response in younger Italian and British patients with high baseline platelet counts and minor duration of the disease, 10 and better results in Japanese patients older than 60 years 40 or in Italian patients not previously treated 7 have been reported. In our series, no differences between responders and nonresponders were noted in sex ratio, mean age, disease duration, previous treatments, and baseline platelet counts.…”

“…No differences in the virulence profile of cagA, vacA, and iceA strains were found in Japanese patients with ITP compared with control patients with ulcer or gastritis. 40 On the other hand, other Japanese investigators found no differences in H pylori virulence factors between responder and nonresponder patients with ITP. 13 The association of Table 6.…”