Download PDF
Semin Thromb Hemost 2012; 38(05): 463-468
DOI: 10.1055/s-0032-1305781
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Helicobacter Pylori-Associated Idiopathic Thrombocytopenic Purpura: A Narrative Review

Massimo Franchini
1   Dipartimento di Medicina Trasfusionale ed Ematologia, Azienda Ospedaliera C. Poma, Mantova, Italy
,
Pier Paolo Vescovi
2   Divisione di Medicina, Azienda Ospedaliera C. Poma, Mantova, Italy
,
Massimo Garofano
2   Divisione di Medicina, Azienda Ospedaliera C. Poma, Mantova, Italy
,
Dino Veneri
3   Dipartimento di Medicina Sperimentale e Clinica, Sezione di Ematologia, Azienda Ospedaliera Universitaria Integrata di Verona, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
06 March 2012 (online)

    Permissions and Reprints

Abstract

The Gram-negative bacterium Helicobacter pylori has a well-demonstrated role in several gastroduodenal diseases, including peptic ulcer disease, chronic active gastritis, mucosa-associated lymphoid tissue lymphoma, and gastric adenocarcinoma. In addition, more recently, several studies have focused on the possible causal role of H. pylori in various extragastric disorders, such as cardiovascular, respiratory, neurological, skin, and autoimmune conditions. The current status of the research on the pathogenesis, clinical and therapeutic aspects of H. pylori-associated idiopathic thrombocytopenic purpura in adults and children will be addressed in this narrative review.

Keywords

Helicobacter pylori - thrombocytopenia - bleeding - eradication therapy
 

  • References

  • 1 Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002; 347 (15) 1175-1186
    CrossrefPubMedSearch in Google Scholar
  • 2 Parsonnet J, Hansen S, Rodriguez L , et al. Helicobacter pylori infection and gastric lymphoma. N Engl J Med 1994; 330 (18) 1267-1271
    CrossrefPubMedSearch in Google Scholar
  • 3 Tsang KW, Lam SK. Helicobacter pylori and extra-digestive diseases. J Gastroenterol Hepatol 1999; 14 (9) 844-850
    CrossrefPubMedSearch in Google Scholar
  • 4 Pellicano R, Franceschi F, Saracco G, Fagoonee S, Roccarina D, Gasbarrini A. Helicobacters and extragastric diseases. Helicobacter 2009; 14 (Suppl 1) 58-68
    CrossrefPubMedSearch in Google Scholar
  • 5 Figura N, Franceschi F, Santucci A, Bernardini G, Gasbarrini G, Gasbarrini A. Extragastric manifestations of Helicobacter pylori infection. Helicobacter 2010; 15 (Suppl 1) 60-68
    CrossrefPubMedSearch in Google Scholar
  • 6 Franchini M, Veneri D. Helicobacter pylori infection and immune thrombocytopenic purpura. Haematologica 2003; 88 (10) 1087-1091
    PubMedSearch in Google Scholar
  • 7 Franchini M, Veneri D. Helicobacter pylori infection and immune thrombocytopenic purpura: an update. Helicobacter 2004; 9 (4) 342-346
    CrossrefPubMedSearch in Google Scholar
  • 8 Stasi R, Provan D. Helicobacter pylori and chronic ITP. Hematology (Am Soc Hematol Educ Program) 2008; 206-211
    PubMedSearch in Google Scholar
  • 9 Franchini M, Cruciani M, Mengoli C, Pizzolo G, Veneri D. Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura: a systematic review and meta-analysis. J Antimicrob Chemother 2007; 60 (2) 237-246
    CrossrefPubMedSearch in Google Scholar
  • 10 Arnold DM, Bernotas A, Nazi I , et al. Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review. Haematologica 2009; 94 (6) 850-856
    CrossrefPubMedSearch in Google Scholar
  • 11 Stasi R, Sarpatwari A, Segal JB , et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood 2009; 113 (6) 1231-1240
    CrossrefPubMedSearch in Google Scholar
  • 12 Akiyama H, Onozawa Y. Effect of omeprazole in chronic idiopathic thrombocytopenic purpura. Am J Hematol 1998; 57 (1) 91-92
    CrossrefPubMedSearch in Google Scholar
  • 13 Stasi R, Willis F, Shannon MS, Gordon-Smith EC. Infectious causes of chronic immune thrombocytopenia. Hematol Oncol Clin North Am 2009; 23 (6) 1275-1297
    CrossrefPubMedSearch in Google Scholar
  • 14 Takahashi T, Yujiri T, Shinohara K , et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol 2004; 124 (1) 91-96
    CrossrefPubMedSearch in Google Scholar
  • 15 Franceschi F, Christodoulides N, Kroll MH, Genta RM. Helicobacter pylori and idiopathic thrombocytopenic purpura. Ann Intern Med 2004; 140 (9) 766-767
    PubMedSearch in Google Scholar
  • 16 Yamanishi S, Iizumi T, Watanabe E , et al. Implications for induction of autoimmunity via activation of B-1 cells by Helicobacter pylori urease. Infect Immun 2006; 74 (1) 248-256
    CrossrefPubMedSearch in Google Scholar
  • 17 Asahi A, Nishimoto T, Okazaki Y , et al. Helicobacter pylori eradication shifts monocyte Fcgamma receptor balance toward inhibitory FcgammaRIIB in immune thrombocytopenic purpura patients. J Clin Invest 2008; 118 (8) 2939-2949
    PubMedSearch in Google Scholar
  • 18 Veneri D, Gottardi M, Guizzardi E, Zanuso C, Krampera M, Franchini M. Idiopathic thombocytopenic purpura, Helicobacter pylori infection and HLA class II alleles. Blood 2002; 100: 1926-1927
    PubMedSearch in Google Scholar
  • 19 Gasbarrini A, Franceschi F, Tartaglione R, Landolfi R, Pola P, Gasbarrini G. Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori . Lancet 1998; 352 (9131) 878
    PubMedSearch in Google Scholar
  • 20 Jarque I, Andreu R, Llopis I , et al. Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura. Br J Haematol 2001; 115 (4) 1002-1003
    CrossrefPubMedSearch in Google Scholar
  • 21 Emilia G, Longo G, Luppi M , et al. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood 2001; 97 (3) 812-814
    CrossrefPubMedSearch in Google Scholar
  • 22 Veneri D, Franchini M, Gottardi M , et al. Efficacy of Helicobacter pylori eradication in enhancing platelet count in adult patients with idiopathic thrombocytopenic purpura. Haematologica 2002; 87: 1777-1779
    PubMedSearch in Google Scholar
  • 23 Kohda K, Kuga T, Kogawa K , et al. Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura. Br J Haematol 2002; 118 (2) 584-588
    CrossrefPubMedSearch in Google Scholar
  • 24 Hino M, Yamane T, Park K , et al. Platelet recovery after eradication of Helicobacter pylori in patients with idiopathic thrombocytopenic purpura. Ann Hematol 2003; 82 (1) 30-32
    PubMedSearch in Google Scholar
  • 25 Hashino S, Mori A, Suzuki S , et al. Platelet recovery in patients with idiopathic thrombocytopenic purpura after eradication of Helicobacter pylori . Int J Hematol 2003; 77 (2) 188-191
    CrossrefPubMedSearch in Google Scholar
  • 26 Ando K, Shimamoto T, Tauchi T , et al. Can eradication therapy for Helicobacter pylori really improve the thrombocytopenia in idiopathic thrombocytopenic purpura? Our experience and a literature review. Int J Hematol 2003; 77 (3) 239-244
    CrossrefPubMedSearch in Google Scholar
  • 27 Takahashi T, Yujiri T, Shinohara K , et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol 2004; 124 (1) 91-96
    CrossrefPubMedSearch in Google Scholar
  • 28 Sato R, Murakami K, Watanabe K , et al. Effect of Helicobacter pylori eradication on platelet recovery in patients with chronic idiopathic thrombocytopenic purpura. Arch Intern Med 2004; 164 (17) 1904-1907
    CrossrefPubMedSearch in Google Scholar
  • 29 Nomura S, Inami N, Kanazawa S. The effects of Helicobacter pylori eradication on chemokine production in patients with immune thrombocytopenic purpura. Eur J Haematol 2004; 72 (4) 304-305
    CrossrefPubMedSearch in Google Scholar
  • 30 Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Does Helicobater pylori initiate or perpetuate immune thrombocytopenic purpura?. Blood 2004; 103 (3) 890-896
    PubMedSearch in Google Scholar
  • 31 Inaba T, Mizuno M, Take S , et al. Eradication of Helicobacter pylori increases platelet count in patients with idiopathic thrombocytopenic purpura in Japan. Eur J Clin Invest 2005; 35 (3) 214-219
    CrossrefPubMedSearch in Google Scholar
  • 32 Veneri D, De Matteis G, Solero P , et al. Analysis of B- and T-cell clonality and HLA class II alleles in patients with idiopathic thrombocytopenic purpura: correlation with Helicobacter pylori infection and response to eradication treatment. Platelets 2005; 16 (5) 307-311
    CrossrefPubMedSearch in Google Scholar
  • 33 Fujimura K, Kuwana M, Kurata Y , et al. 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. Int J Hematol 2005; 81 (2) 162-168
    CrossrefPubMedSearch in Google Scholar
  • 34 Suzuki T, Matsushima M, Masui A , et al. Effect of Helicobacter pylori eradication in patients with chronic idiopathic thrombocytopenic purpura-a randomized controlled trial. Am J Gastroenterol 2005; 100 (6) 1265-1270
    CrossrefPubMedSearch in Google Scholar
  • 35 Stasi R, Rossi Z, Stipa E, Amadori S, Newland AC, Provan D. Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura. Am J Med 2005; 118 (4) 414-419
    CrossrefPubMedSearch in Google Scholar
  • 36 Asahi A, Kuwana M, Suzuki H, Hibi T, Kawakami Y, Ikeda Y. Effects of a Helicobacter pylori eradication regimen on anti-platelet autoantibody response in infected and uninfected patients with idiopathic thrombocytopenic purpura. Haematologica 2006; 91 (10) 1436-1437
    PubMedSearch in Google Scholar
  • 37 Suvajdzić N, Stanković B, Artiko V , et al. Helicobacter pylori eradication can induce platelet recovery in chronic idiopathic thrombocytopenic purpura. Platelets 2006; 17 (4) 227-230
    CrossrefPubMedSearch in Google Scholar
  • 38 Kodama M, Kitadai Y, Ito M , et al. Immune response to CagA protein is associated with improved platelet count after Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura. Helicobacter 2007; 12 (1) 36-42
    PubMedSearch in Google Scholar
  • 39 Emilia G, Luppi M, Zucchini P , et al. Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles. Blood 2007; 110 (12) 3833-3841
    CrossrefPubMedSearch in Google Scholar
  • 40 Jackson SC, Beck P, Buret AG , et al. Long-term platelet responses to Helicobacter pylori eradication in Canadian patients with immune thrombocytopenic purpura. Int J Hematol 2008; 88 (2) 212-218
    CrossrefPubMedSearch in Google Scholar
  • 41 Scandellari R, Allemand E, Vettore S, Plebani M, Randi ML, Fabris F. Platelet response to Helicobacter pylori eradication therapy in adult chronic idiopathic thrombocytopenic purpura seems to be related to the presence of anticytotoxin-associated gene A antibodies. Blood Coagul Fibrinolysis 2009; 20 (2) 108-113
    CrossrefPubMedSearch in Google Scholar
  • 42 Takahashi T, Yujiri T, Tanizawa Y. Helicobacter pylori and chronic ITP: the discrepancy in the clinical responses to eradication therapy might be due to differences in the bacterial strains. Blood 2004; 104 (2) 594
    CrossrefPubMedSearch in Google Scholar
  • 43 George JN. Definition, diagnosis and treatment of immune thrombocytopenic purpura. Haematologica 2009; 94 (6) 759-762
    CrossrefPubMedSearch in Google Scholar
  • 44 Zeller B, Helgestad J, Hellebostad M , et al. Immune thrombocytopenic purpura in childhood in Norway: a prospective, population-based registration. Pediatr Hematol Oncol 2000; 17 (7) 551-558
    CrossrefPubMedSearch in Google Scholar
  • 45 Rosthøj S, Hedlund-Treutiger I, Rajantie J , et al; NOPHO ITP Working Group. Duration and morbidity of newly diagnosed idiopathic thrombocytopenic purpura in children: A prospective Nordic study of an unselected cohort. J Pediatr 2003; 143 (3) 302-307
    CrossrefPubMedSearch in Google Scholar
  • 46 De Mattia D, Del Vecchio GC, Russo G , et al; AIEOP-ITP Study Group. Management of chronic childhood immune thrombocytopenic purpura: AIEOP consensus guidelines. Acta Haematol 2010; 123 (2) 96-109
    CrossrefPubMedSearch in Google Scholar
  • 47 Lowe EJ, Buchanan GR. Idiopathic thrombocytopenic purpura diagnosed during the second decade of life. J Pediatr 2002; 141 (2) 253-258
    CrossrefPubMedSearch in Google Scholar
  • 48 Blanchette VS, Price V. Childhood chronic immune thrombocytopenic purpura: unresolved issues. J Pediatr Hematol Oncol 2003; 25 (Suppl 1) S28-S33
    CrossrefPubMedSearch in Google Scholar
  • 49 Jaing TH, Tsay PK, Hung IJ, Chiu CH, Yang CP, Huang IA. The role of Helicobacter pylori infection in children with acute immune thrombocytopenic purpura. Pediatr Blood Cancer 2006; 47 (2) 215-217
    CrossrefPubMedSearch in Google Scholar
  • 50 Li CX, Liu DJ, Pan CQ, Sang XF, Li X. Effect of Helicobacter pylori eradication on childhood acute idiopathic thrombocytopenic purpura. Nan Fang Yi Ke Da Xue Xue Bao 2009; 29: 1243-1244
    PubMedSearch in Google Scholar
  • 51 Rajantie J, Klemola T. Helicobacter pylori and idiopathic thrombocytopenic purpura in children. Blood 2003; 101 (4) 1660
    CrossrefPubMedSearch in Google Scholar
  • 52 Yetgin S, Demir H, Arslan D, Unal S, Koçak N. Autoimmune thrombocytopenic purpura and Helicobacter pylori infection effectivity during childhood. Am J Hematol 2005; 78 (4) 318
    PubMedSearch in Google Scholar
  • 53 Loffredo G, Marzano MG, Migliorati R , et al. The relationship between immune thrombocytopenic purpura and Helicobacter pylori infection in children: where is the truth?. Eur J Pediatr 2007; 166 (10) 1067-1068
    CrossrefPubMedSearch in Google Scholar
  • 54 Hamidieh AA, Arzanian MT, Gachkar L, Pasha F. Helicobacter pylori infection in children with chronic idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol 2008; 30 (1) 96-97
    CrossrefPubMedSearch in Google Scholar
  • 55 Bisogno G, Errigo G, Rossetti F , et al. The role of Helicobacter pylori in children with chronic idiopathic thrombocytopenic purpura. J Pediatr Hematol Oncol 2008; 30 (1) 53-57
    CrossrefPubMedSearch in Google Scholar
  • 56 Treepongkaruna S, Sirachainan N, Kanjanapongkul S , et al. Absence of platelet recovery following Helicobacter pylori eradication in childhood chronic idiopathic thrombocytopenic purpura: a multi-center randomized controlled trial. Pediatr Blood Cancer 2009; 53 (1) 72-77
    CrossrefPubMedSearch in Google Scholar
  • 57 Jaing TH, Yang CP, Hung IJ, Chiu CH, Chang KW. Efficacy of Helicobacter pylori eradication on platelet recovery in children with chronic idiopathic thrombocytopenic purpura. Acta Paediatr 2003; 92 (10) 1153-1157
    CrossrefPubMedSearch in Google Scholar
  • 58 Hayashi H, Okuda M, Aoyagi N , et al. Helicobacter pylori infection in children with chronic idiopathic thrombocytopenic purpura. Pediatr Int 2005; 47 (3) 292-295
    CrossrefPubMedSearch in Google Scholar
  • 59 Neefjes VM, Heijboer H, Tamminga RYH. H. pylori infection in childhood chronic immune thrombocytopenic purpura. Haematologica 2007; 92 (4) 576
    CrossrefPubMedSearch in Google Scholar
  • 60 Ferrara M, Capozzi L, Russo R. Effect of Helicobacter pylori eradication on platelet count in children with chronic idiopathic thrombocytopenic purpura. Hematology 2009; 14 (5) 282-285
    CrossrefPubMedSearch in Google Scholar
  • 61 Russo G, Miraglia V, Branciforte F , et al; AIEOP-ITP Study Group. Effect of eradication of Helicobacter pylori in children with chronic immune thrombocytopenia: a prospective, controlled, multicenter study. Pediatr Blood Cancer 2011; 56 (2) 273-278
    CrossrefPubMedSearch in Google Scholar
  • 62 Schipperus M, Fijnheer R. New therapeutic options for immune thrombocytopenia. Neth J Med 2011; 69 (1) 480-485
    PubMedSearch in Google Scholar
  • 63 Provan D, Stasi R, Newland AC , et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115 (2) 168-186
    CrossrefPubMedSearch in Google Scholar