Absence of platelet recovery following Helicobacter pylori eradication in childhood chronic idiopathic thrombocytopenic purpura: a multi-center randomized controlled trial.
OBJECTIVE
To investigate the effect of Helicobacter pylori eradication on platelet recovery in childhood chronic idiopathic thrombocytopenic purpura (ITP).


METHODS
A multi-center randomized controlled trial was conducted. Patients aged 4-18 years, diagnosed with chronic ITP, defined by platelet count below 100 x 10(9)/L lasting more than 6 months without identified causes, were enrolled and underwent (13)C-urea breath test for diagnosis of H. pylori infection. Patients who received prednisolone more than 0.5 mg/kg per day or received other platelet-enhancing therapy were excluded. Patients with H. pylori infection were randomized into two groups: treatment and control groups. Treatment group received a standard protocol for H. pylori eradication and repeated (13)C-UBT at 4-6 weeks to confirm successful therapy while the control group received no specific treatment. Monthly platelet count was monitored for 6 months in both groups. Primary outcome was platelet recovery, defined by platelet count over 100 x 10(9)/L for at least 3 months.


RESULTS
Of the 55 ITP children, 16 (29.1%) had H. pylori infection. There were no differences in age, sex, duration of disease, platelet count, and the dose of prednisolone between the treatment group (n = 7) and control group (n = 9). One patient in control group was withdrawn due to massive gastrointestinal bleeding requiring a high dose prednisolone. At 6 months, platelet recovery was demonstrated in one patient in the treatment group as well as one in the control group.


CONCLUSIONS
No beneficial effect of H. pylori eradication on platelet recovery in childhood chronic ITP was identified.
Treepongkaruna
Suporn
S
Faculty of Medicine, Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. rastp@mahidol.ac.th
Sirachainan
Nongnuch
N
Kanjanapongkul
Somjai
S
Winaichatsak
Angkana
A
Sirithorn
Suebsuk
S
Sumritsopak
Rungtip
R
Chuansumrit
Ampaiwan
A
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D016481:Helicobacter Infections / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D016480:Helicobacter pylori / Q000472:pathogenicity; D006801:Humans; D008297:Male; D010976:Platelet Count; D011239:Prednisolone / Q000008:administration & dosage; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000097:blood* / Q000150:complications*; D012074:Remission Induction
D011239:Prednisolone