Evidence-Based Medicine
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World J Gastroenterol. Jun 14, 2014; 20(22): 6918-6923
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6918
Helicobacter pylori eradication in patients with chronic immune thrombocytopenic purpura
Ravinder Naik Noonavath, Chandrasekharan Padma Lakshmi, Tarun Kumar Dutta, Vikram Kate
Ravinder Naik Noonavath, Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
Chandrasekharan Padma Lakshmi, Department of Medical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
Tarun Kumar Dutta, Department of Clinical Hematology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
Vikram Kate, Department of General and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India
Author contributions: Noonavath RN collected data, compiled the manuscript, literature review; Lakshmi CP performed data interpretation, literature review; Dutta TK contributed to data analysis, data interpretation, literature review, and supervised manuscript preparation; Kate V contributed to data analysis, design and overall conceptualization of the manuscript.
Correspondence to: Vikram Kate, MS, FRCS (Eng.), FRCS (Ed.), FRCS (Glasg.), PhD (Surg. Gastro.), MAMS, FIMSA, MASCRS, FACS, FACG, Professor of General and Gastrointestinal Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry 605006, India. drvikramkate@gmail.com
Telephone: +91-413-2203330 Fax: +91-413-2272066
Received: December 7, 2013
Revised: January 18, 2014
Accepted: March 8, 2014
Published online: June 14, 2014
Abstract

AIM: To assess the effect of Helicobacter pylori (H. pylori) eradication on platelet counts in patients with chronic immune thrombocytopenic purpura (cITP).

METHODS: A total of 36 cITP patients were included in the study. The diagnosis of H. pylori was done by rapid urease test and Giemsa staining of the gastric biopsy specimen. All H. pylori positive patients received standard triple therapy for 14 d and were subjected for repeat endoscopy at 6 wk. Patients who continued to be positive for H. pylori on second endoscopy received second line salvage therapy. All the patients were assessed for platelet response at 6 wk, 3rd and 6th months.

RESULTS: Of the 36 patients, 17 were positive for H. pylori infection and eradication was achieved in 16 patients. The mean baseline platelet count in the eradicated patients was 88615.38 ± 30117.93/mm3 and platelet count after eradication at 6 wk, 3 mo and 6 mo was 143230.77 ± 52437.51/mm3 (P = 0.003), 152562.50 ± 52892.3/mm3 (P = 0.0001), 150187.50 ± 41796.68/mm3 (P = 0.0001) respectively and in the negative patients, the mean baseline count was 71000.00 ± 33216.46/mm3 and at 6 wk, 3rd and 6th month follow up was 137631.58 ± 74364.13/mm3 (P = 0.001), 125578.95 ± 71472.1/mm3 (P = 0.005), 77210.53 ± 56892.28/mm3 (P = 0.684) respectively.

CONCLUSION: Eradication of H. pylori leads to increase in platelet counts in patients with cITP and can be recommended as a complementary treatment with conventional therapy.

Keywords: Helicobacter pylori, Immune thrombocytopenic purpura, Platelet counts

Core tip: Immune thrombocytopenic purpura (ITP) is an autoimmune haematological disorder in which destruction of platelets is mediated by auto-antibodies in the reticuloendothelial system. Some studies have demonstrated improvement in the platelet count after Helicobacter pylori (H. pylori) eradication in cITP. The present study describes the effect of H. pylori eradication on the platelet count in patients with cITP. It was found that following H. pylori eradication there was a significant sustained rise in the platelet count at 6 wk, 3rd and 6th months following eradication. In patients where conventional therapy was administrated, although there was a significant rise in the platelet count at 6 wk and 3rd month, it was found that at 6th month the platelet count was similar to the baseline pre therapy level.