Is eradication therapy useful as the first line of treatment in Helicobacter pylori-positive idiopathic thrombocytopenic purpura? Analysis of 207 eradicated chronic ITP cases in Japan.
A retrospective study was performed to determine the prevalence of Helicobacter pylori (H pylori) infection, the effect of H pylori eradication on platelet counts, and the characteristic clinical features of chronic immune or idiopathic thrombocytopenic purpura (ITP) with H pylori infection. H pylori infection was found in 300 patients, a group that was significantly older (P < .005) and had more cases of hyperplastic megakaryocytes in the bone marrow (P = .01) than patients without H pylori infection. H pylori eradication therapy was performed in 207 H pylori-positive ITP cases, and the platelet count response was observed in 63% of the successful eradication group and in 33% of the unsuccessful eradication group (P < .005). In the successful group, the complete remission and partial remission rates were 23% and 42%, respectively, 12 months after eradication. In the majority of responders, the platelet count response occurred 1 month after eradication therapy, and the increased platelet count continued without ITP treatment for more than 12 months. H pylori eradication therapy was effective even in refractory cases, which were unresponsive to splenectomy. In conclusion, H pylori infection was involved in most ITP patients older than 40 years in Japan, and eradication therapy should be the first line of treatment in H pylori-positive ITP patients.
Fujimura
Kingo
K
Department of Hematology and Oncology, Division of Clinical Pharmacotherapeutics, Graduate School of Biomedical Sciences, Hiroshima University, Japan. fujimura@hiroshima-u.ac.jp
Kuwana
Masataka
M
Kurata
Yoshiyuki
Y
Imamura
Masahiro
M
Harada
Hiroshi
H
Sakamaki
Hisashi
H
Teramura
Masanao
M
Koda
Kyuhei
K
Nomura
Shosaku
S
Sugihara
Sayaka
S
Shimomura
Takeshi
T
Fujimoto
Tetsuro-Takahiro
TT
Oyashiki
Kazuma
K
Ikeda
Yasuo
Y
D000328:Adult; D017677:Age Distribution; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D016480:Helicobacter pylori; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D015995:Prevalence; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology / Q000382:microbiology*; D012074:Remission Induction; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents