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

Emilia, Giovanni; Luppi, Mario; Zucchini, Patrizia; Morselli, Monica; Potenza, Leonardo; Forghieri, Fabio; Volzone, Francesco; Jovic, Gordana; Leonardi, Giovanna; Donelli, Amedea; Torelli, Giuseppe

doi:10.1182/blood-2006-12-063222

Cited by 75 publications

(67 citation statements)

References 55 publications

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“…In contrast, the American study by Michel 11 showed no significant difference between groups [1/15 (6.7%) vs. 0/10 (0%)]. Among responders, the mean time to response was 2.7 weeks (range 1-6), [10][11][12][15][16][17] and the mean duration of response was 19.9 months (range 7-60) measured to the end of follow-up. [10][11][12][13]15,[17][18] Of 12 patients whose infection could not be eradicated with treatment, 3 (25.0%, 95% CI 5% to 57%) achieved a platelet count response.…”

Section: Responsementioning

confidence: 58%

“…Among responders, the mean time to response was 2.7 weeks (range 1-6), [10][11][12][15][16][17] and the mean duration of response was 19.9 months (range 7-60) measured to the end of follow-up. [10][11][12][13]15,[17][18] Of 12 patients whose infection could not be eradicated with treatment, 3 (25.0%, 95% CI 5% to 57%) achieved a platelet count response. 10,[15][16] The median platelet count increase by group could not be derived because of insufficient data from primary reports, and an analysis by severity of thrombocytopenia was not possible with the study-level data available for this review.…”

Section: Responsementioning

confidence: 99%

“…The OR (OR; positive vs. negative) was 24.0, exact 95% CI 7.1 to 125.1. Using the homogeneous definition of a platelet count increase to 30×10 9 /L or higher by six months, [10][11][12][13]15,18 overall platelet count response was 51.2%, 52.5% and 8.8% for positive (n=125), eradicated (n=115) and negative (n=57), respectively; OR (positive vs. negative) 14. We performed a descriptive sensitivity analysis using only those studies that enrolled consecutive patients whose infection status was not known until after the effect of treatment had been assessed (n=4 studies).…”

Section: Responsementioning

confidence: 99%

“…[10][11][12][13]15,[17][18] Of 12 patients whose infection could not be eradicated with treatment, 3 (25.0%, 95% CI 5% to 57%) achieved a platelet count response. 10,[15][16] The median platelet count increase by group could not be derived because of insufficient data from primary reports, and an analysis by severity of thrombocytopenia was not possible with the study-level data available for this review. None of the studies reported bleeding or quality of life measures.…”

Section: Responsementioning

confidence: 99%

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

Arnold¹,

Bernotas²,

Nazi³

et al. 2009

Haematologica

119

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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. Citation

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Section: Responsementioning

confidence: 58%

Section: Responsementioning

confidence: 99%

Section: Responsementioning

confidence: 99%

Section: Responsementioning

confidence: 99%

See 2 more Smart Citations

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

Arnold¹,

Bernotas²,

Nazi³

et al. 2009

Haematologica

119

View full text Add to dashboard Cite

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“…Primary immune thrombocytopenia [26][27][28][29][30][31][32][33]36,37,40,43,48,62 Low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma [50][51][52][53]62 Controversial hematologic associations with H. pylori infection Pernicious anemia [54][55][56] Monoclonal gammopathy of undetermined significance 57,58 Myelodysplastic syndrome 59 …”

mentioning

confidence: 99%

Helicobacter pyloriInfection and Hematologic Diseases

Kim

Cho

2013

Korean J Helicobacter Up Gastrointest Res

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Risk of Immune Thrombocytopenic Purpura and Autoimmune Hemolytic Anemia Among 120 908 US Veterans With Hepatitis C Virus Infection

et al. 2009

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Background There is emerging evidence that Hepatitis C virus (HCV) infection plays a role in the etiology of immune thrombocytopenia purpura (ITP) and autoimmune hemolytic anemia (AIHA) which both are severe autoimmune cytopenias. Methods In order to determine if HCV infection increases the risk for ITP and AIHA, we calculated the incidence rates of ITP and AIHA among 120,691 HCV-infected and 454,905 matched HCV-uninfected U.S. veterans diagnosed 1997–2004. After excluding individuals with a prior diagnosis of a lymphoproliferative disease, HIV, or cirrhosis, we fit Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) as measures of risks. Results We found 296 ITP and 90 AIHA cases. Among HCV-infected versus HCV-uninfected persons, the overall incidence rates of ITP were 30.2 and 18.5 per 100,000 person-years, and for AIHA they were 11.4 and 5.0 per 100,000 person-years, respectively. HCV was associated with elevated risks for ITP (HR=1.8, 95% CI 1.4–2.3) and AIHA (HR=2.8, 95% CI 1.8–4.2). ITP incidence was increased among both untreated and treated HCV-infected persons (HR 1.7, 95% CI 1.3–2.2, and HR 2.4, 95% CI 1.5–3.7, respectively), whereas AIHA incidence was elevated only among treated HCV-infected persons (HR 11.6, 95% CI 7.0–19.3). Conclusions Individuals infected with HCV are at an increased risk for ITP, while the development of AIHA appears to be associated with HCV treatment. It may be beneficial to test individuals newly diagnosed with ITP for HCV infection.

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

Abstract: Eradication of

Cited by 75 publications

References 55 publications

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

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

Helicobacter pyloriInfection and Hematologic Diseases

Risk of Immune Thrombocytopenic Purpura and Autoimmune Hemolytic Anemia Among 120 908 US Veterans With Hepatitis C Virus Infection

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