Efficacy of Helicobacter pylori eradication on platelet recovery in children with chronic idiopathic thrombocytopenic purpura.
OBJECTIVE
Little is known about the influence of environmental factors on the epidemiology of idiopathic thrombocytopenic purpura (ITP). The role of Helicobacter pylori infection in relation to the development and/or persistence of ITP in infected patients remains controversial. Therapy used for eradicating H. pylori has led to a rise in platelet counts in a significant number of adult patients. but few paediatric studies have been undertaken to evaluate such treatment. The aim of this prospective study was to determine the prevalence of H. pylori and to evaluate whether H. pylori eradication can induce chronic ITP regression in children.


METHODS
To investigate new, noninvasive techniques for diagnosis of H. pylori infection, an enzyme immunoassay for H. pylori antigens in faeces (HpSA) was evaluated. Patient eligibility criteria included isolated thrombocytopenia (< or = 50 x 10(9) L-(-1)) for more than 6 months without any identifiable cause and either normal or increased marrow megakaryocytes. H. pylori status was monitored before eradication and 4, 12, and 24 mo, after the end of treatment using Premier Platinum HpSA.


RESULTS
In this study we evaluated 22 chronic ITP patients, 9 of whom were infected with H. pylori. Using repeated HpSA testing, we demonstrated for eradication of H. pylori after treatment in all infected patients. Five of the nine patients had increased platelet counts that persisted throughout the follow-up period.


CONCLUSIONS
These results should stimulate additional research into the involvement of H. pylori infection in chronic ITP in childhood. This approach may offer an accepted algorithm at least for some of these patients.
Jaing
T H
TH
Department of Paediatrics, Division of Haematology/Oncology, Chang Gung Children's Hospital, Taoyuan, Taiwan. jaing001@cgmh.org.tw
Yang
C P
CP
Hung
I J
IJ
Chiu
C H
CH
Chang
K W
KW
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000302:isolation & purification; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D010976:Platelet Count; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial