title: Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles.
abstract: Eradication of Helicobacter pylori may lead to improvement of chronic immune thrombocytopenic purpura (ITP), although its efficacy over time is uncertain. We report the results of H pylori screening and eradication in 75 consecutive adult patients with ITP. We also used molecular methods to investigate lymphocyte clonality and H pylori genotypes in the gastric biopsies from 10 H pylori-positive patients with ITP and 19 H pylori-positive patients without ITP with chronic gastritis. Active H pylori infection was documented in 38 (51%) patients and successfully eradicated in 34 (89%) patients. After a median follow-up of 60 months, a persistent platelet response in 23 (68%) of patients with eradicated infection was observed; 1 relapse occurred. No differences in mucosal B- or T-cell clonalities were observed between patients with ITP and control participants. Of note, the frequency of the H pylori cagA gene (P = .02) and the frequency of concomitant H pylori cagA, vacAs1, and iceA genes (triple-positive strains; P = .015) resulted statistically higher in patients with ITP than in control participants. All asymptomatic H pylori-positive patients with ITP were suffering from chronic gastritis. Our data suggest a sustained platelet recovery in a proportion of patients with ITP by H pylori eradication alone. Overrepresentation of specific H pylori genotypes in ITP suggests a possible role for bacterium-related factors in the disease pathogenesis.
authors.affiliation: Department of Oncology and Hematology, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy. emilia.giovanni@unimore.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Emilia
authors.forename: Mario
authors.initials: M
authors.lastname: Luppi
authors.forename: Patrizia
authors.initials: P
authors.lastname: Zucchini
authors.forename: Monica
authors.initials: M
authors.lastname: Morselli
authors.forename: Leonardo
authors.initials: L
authors.lastname: Potenza
authors.forename: Fabio
authors.initials: F
authors.lastname: Forghieri
authors.forename: Francesco
authors.initials: F
authors.lastname: Volzone
authors.forename: Gordana
authors.initials: G
authors.lastname: Jovic
authors.forename: Giovanna
authors.initials: G
authors.lastname: Leonardi
authors.forename: Amedea
authors.initials: A
authors.lastname: Donelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Torelli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial / Q000096:biosynthesis / Q000235:genetics; D001402:B-Lymphocytes / Q000378:metabolism / Q000473:pathology; D001425:Bacterial Outer Membrane Proteins / Q000096:biosynthesis / Q000235:genetics; D001426:Bacterial Proteins / Q000096:biosynthesis / Q000235:genetics; D001792:Blood Platelets / Q000378:metabolism / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005756:Gastritis / Q000097:blood / Q000150:complications / Q000235:genetics / Q000382:microbiology*; D005838:Genotype; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications / Q000235:genetics* / Q000628:therapy; D016480:Helicobacter pylori / Q000235:genetics* / Q000378:metabolism / Q000472:pathogenicity*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood / Q000150:complications / Q000235:genetics / Q000382:microbiology* / Q000473:pathology / Q000628:therapy; D020127:Recovery of Function; D013601:T-Lymphocytes / Q000378:metabolism / Q000473:pathology
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D001426:Bacterial Proteins; C074689:VacA protein, Helicobacter pylori; C080866:cagA protein, Helicobacter pylori; C063113:ice nucleation protein