Etiology and risk factors of gastric cancer after Helicobacter pylori eradication in Fuzhou area / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics and risk factors of gastric cancer after eradication of ( Helicobacter pylori , Hp) in Fuzhou area, to provide a theoretical basis for reducing the incidence and mortality of gastric cancer after eradication of Hp, and to provide effective suggestions for the prevention of gastric cancer in residents in Fuzhou. Methods A total of 699 patients with Hp eradication admitted to our hospital from January 2020 to December 2020 were selected. According to whether the patients had gastric cancer after eradication, they were divided into control group (no gastric cancer) and observation group (gastric cancer). The serum levels of tumor markers including CEA, CA125 and CA199 were detected and compared between the two groups. Clinical data of the two groups, including age, sex, family history of gastric cancer, course of Hp infection, open atrophy, severe atrophy of gastric mucosa, presence of intestinal metaplasia (IM) of gastric mucosa, xanxoma of gastric mucosa, and long-term use of proton pump inhibitors (PPIs), were analyzed using the self-made survey scale in our hospital. Univariate analysis and logistic regression were used to analyze the risk factors for gastric cancer after Hp eradication. Results Among of 699 patients with Hp eradication, 48 cases (6.96%) developed gastric cancer, including 29 male cases and 19 female cases. The incidence rate of males was significantly higher than that of females (P3 years between the two groups (P3 years (OR=3.631) were independent risk factors for gastric cancer after Hp eradication (P<0.05). Conclusion There is a high risk of gastric cancer after HP eradication in Fuzhou, mainly in elderly male patients, especially in patients with IM, severe atrophy of gastric mucosa and long-term use of PPIs, often accompanied by elevated levels of tumor markers. Close gastroscopy follow-up examination must be conducted within 4 to 5 years after Hp eradication, which is helpful for screening high-risk groups of gastric cancer, preventing gastric cancer and treating gastric cancer as early as possible after Hp eradication.

Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil

Abstract Background: Several studies have demonstrated that platelet counts in Helicobacter pylori-positive patients with chronic idiopathic thrombocytopenic purpura improved significantly after successful eradication of the infection. However, depending of the geographical region of the study the results have been highly divergent. Objective: The purpose of this study was to evaluate the effect of H. pylori eradication therapy on platelet count in a cohort of chronic idiopathic thrombocytopenic purpura patients from northeastern Brazil. Method: H. pylori status was determined in 28 chronic idiopathic thrombocytopenic purpura patients using the rapid urease test and histology. H. pylori-positive patients received standard triple therapy for one week. The effect of the eradication therapy was evaluated using the 13C-urea breath test two to three months after treatment. Results: The prevalence of H. pylori infection was similar to that found in the general population. Twenty-two patients (78.5%) were H. pylori-positive. Fifteen were treated, 13 (86%) of whom successfully. At six months, 4/13 (30%) displayed increased platelet counts, which remained throughout follow-up (12 months). Platelet response was not associated to mean baseline platelet count, duration of chronic idiopathic thrombocytopenic purpura, gender, age, previous use of medication, or splenectomy. Conclusions: H. pylori eradication therapy showed relatively low platelet recovery rates, comparable with previous studies from southeastern Brazil. The effect of H. pylori eradication on platelet counts remained after one year of follow-up suggesting that treating H. pylori infection might be worthwhile in a subset of chronic idiopathic thrombocytopenic purpura patients.

Seven days triple therapy for eradication of Helicobacter pylori does not alter the disease activity of patients with inflammatory bowel disease

BACKGROUND/AIMS: The influences of Helicobacter pylori eradication therapy on the disease course of inflammatory bowel disease (IBD) are still unclear. We therefore conducted a multicenter, retrospective cohort study to evaluate the safety of H. pylori eradication therapy for IBD patients. METHODS: IBD patients with H. pylori eradication from 2005 to 2015 (eradication group) and control patients (non-eradication group; 2 paired IBD patients without H. pylori eradication matched with each eradicated patient) were included. IBD exacerbation (increased/additional IBD drug or IBD-associated hospitalization/surgery) and disease improvement based on the physicians’ global assessment were investigated at baseline, and at 2 and 6 months after eradication or observation. RESULTS: A total of 429 IBD (378 ulcerative colitis, 51 Crohn’s disease) patients, comprising 144 patients in the eradication group and 285 patients in the non-eradication group, were enrolled at 25 institutions. IBD exacerbation was comparable between groups (eradication group: 8.3% at 2 months [odds ratio, 1.76; 95% confidence interval, 0.78–3.92; P=0.170], 11.8% at 6 months [odds ratio, 1.60; 95% confidence interval, 0.81–3.11; P=0.172]). Based on the physicians’ global assessment at 2 months, none of the patients in the eradication group improved, whereas 3.2% of the patients in the non-eradication group improved (P=0.019). Multivariate analysis revealed that active disease at baseline, but not H. pylori eradication, was an independent factor for IBD exacerbation during 2 months’ observation period. The overall eradication rate was 84.0%–comparable to previous reports in non-IBD patients. CONCLUSIONS: H. pylori eradication therapy does not alter the short-term disease activity of IBD.

Effect of Helicobacter pylori eradication on the regression of gastric polyps in National Cancer Screening Program

BACKGROUND/AIMS: Western guidelines recommend Helicobacter pylori eradication in H. pylori-associated gastric polyps; however, there is no standard guideline in Korea. The aim of this study is to assess the effect of H. pylori eradication on the regression of gastric hyperplastic polyps in National Cancer Screening Cohort, representative of general population. METHODS: Among participants in National Cancer Screening Program, subjects who had H. pylori positive gastric hyperplastic polyps less than 10 mm and underwent follow-up endoscopy and H. pylori testing were enrolled. The effect of H. pylori eradication on hyperplastic gastric polyps was estimated using odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: A total of 183 H. pylori infected subjects with hyperplastic polyp at baseline underwent follow-up endoscopy and H. pylori test after mean of 2.2 years. Successful H. pylori eradication markedly induced the disappearance of hyperplastic polyps comparing to non-eradication group (83.7% vs. 34.1%, p = 0.001). Successful eradication increased the possibility of disappearance of hyperplastic polyps (adjusted OR, 5.56; 95% CI, 2.63 to 11.11). Polyp size was inversely related with the disappearance of hyperplastic polyps (adjusted OR, 59; 95% CI, 0.48 to 0.71). CONCLUSIONS: Eradication of H. pylori infection may induce disappearance of gastric hyperplastic polyps in National Cancer Screening Cohort.

Characteristics of Primary and Metachronous Gastric Cancers Discovered after Helicobacter pylori Eradication: A Multicenter Propensity Score-Matched Study

BACKGROUND/AIMS: Gastric cancers develop even after successful Helicobacter pylori eradication. We aimed to clarify the characteristics of early gastric cancers discovered after H. pylori eradication. METHODS: A total of 1,053 patients with early gastric cancer treated by endoscopic submucosal dissection were included. After matching the propensity score, we retrospectively investigated the clinicopathological features of 192 patients, including 96 patients who had undergone successful H. pylori eradication (Hp-eradicated group) and 96 patients who had active H. pylori infection (Hp-positive group). RESULTS: In the Hp-eradicated group, early gastric cancers were discovered 1 to 15 years (median, 4.1 years) after H. pylori eradication. Compared with Hp-positive patients, Hp-eradicated patients showed a more frequently depressed configuration (81% vs 53%, respectively, p<0.0001) and a higher trend toward submucosal invasion (18% vs 8%, respectively, p=0.051). A multivariable analysis revealed the macroscopic depressed type to be characteristics of early gastric cancers after H. pylori eradication. Among patients in the Hp-eradicated group, metachronous cancers showed less frequent depressed lesions (68% vs 84%, respectively, p=0.049) and smaller tumor sizes (median, 11 mm vs 14 mm, respectively, p=0.014) than primary cancers. CONCLUSIONS: Early gastric cancers after H. pylori eradication are characterized by a depressed configuration. Careful follow-up endoscopies are necessary after H. pylori eradication.

Cost-Effectiveness Analysis of Clinical Pharmaceutical Care in Helicobacter pylori Eradication of Peptic Ulcer Outpatients / 中国药学杂志

OBJECTIVE: To assess the cost-effectiveness of clinical pharmaceutical care in the H. pylori(HP) eradication in outpatients with peptic ulcer. METHODS: Ninty-six Outpatients with HP positive peptic ulcer from July 2015 to June 2016 were prospectively collected, and randomly divide into control group and intervention group. Patients in the control group were given the traditional outpatient service. The intervention group patients were given with pharmaceutical education and follow-up by clinical pharmacist. The score of compliance with medication, HP eradication rate and the improvement of gastrointestinal symptom were selected as outcome indicator. Time cost of intervention and fee of clinical pharmacist training were estimated and recorded as the cost of clinical pharmacy intervention. RESULTS: (1)Improvement of the score of compliance with medication of intervention group patients was significantly higher than the control group (1.71 vs. 0.44, P<0.01). Forty-four patients of the intervention group, while 36 patients in the control group reported less gastrointestinal symptoms (91.67% vs. 75.00%, P=0.028). The HP eradication rate of the intervention group was significantly higher than the control group (91.67% vs. 72.92%, P=0.016). (2)For the hospital, the cost of pharmacy service of control group was 292.31 yuan, and 821.61 yuan of the intervention group. (3)The cost-effectiveness ratio of the score of compliance with medication of control group was 664.34, while the intervention group was 480.47, which was superior to the control group. It was cost-effective. However, the cost-effectiveness ratio of HP eradication rate and the improvement of gastrointestinal symptom of the intervention group were both higher than the control group. CONCLUSION: Clinical pharmaceutical care increase the cost of the hosipital. However, clinical pharmaceutical care can result in cost-effective improvement of the medication compliance.

Meta-analysis of the efficacy of Bifidobacterium preparation in Helicobacter pylori eradication therapy / 中国生化药物杂志

Objective To systematic review the efficacy of Bifidobacterium preparation in Helicobacter pylori ( HP ) eradication therapy. Methods We systematically reviewed clinical research about the efficacy of probiotics in Helicobacter pylori eradication in multiple data-base( PubMed, EMBASE, Medline, OVID, Web of Science); After screening and assessing the quality of the data, we used RevMan 5.3.5 software and Stata 12.0 software for data analysis, then we used GRADE pro3.6.1 software assessing the quality of results.Results Six studies were included with 1396 patients,there were 690 patients in experimental group and 706 patients in control group.Compared with control group, the eradication rates calculated by per-protocol analysis [RR=1.19,95%CI(1.12,1.26),Z=5.87 (P<0.00001)]and intention-to-treat analysis[RR=1.18,95%CI(1.07,1.31),Z=3.33(P=0.0009)]in experimental group was higher,the number of diarrhea[RR=0.43,95%CI(0.23,0.79),Z=2.73(P=0.006)]/the number of nausea[RR=0.67,95%CI(0.56,0.81),Z=4.19 (P<0.0001)]/the number of taste disorders[RR=0.61,95%CI(0.32,1.13),Z=1.57(P=0.12)]in experimental group was lower.The quality of results:the eradication rates calculated by per-protocol analysis was high quality, intention-to-treat analysis and the number of nausea and the number of diarrhea was moderate quality,the number of taste disorders was low quality.Egger’s test showed there was no evidence of substantial publication bias.Conclusion Bifidobacterium preparations during standard triple HP therapy may improve the eradication rate and reduce adverse reactions.

Eficacia de la erradicación del Helicobacter pylori en la prevención del cáncer gástrico: Revisión sistemática y metanálisis / Efficacy of Eradicating Helicobacter Pylori for Prevention of Gastric Cancer: Systematic Review and Meta-Analysis

Esta revisión sistemática y metanálisis ha tenido como objetivo definir la eficacia de la erradicación de Helicobacter pylori sobre la prevención del cáncer gástrico. Realizamos una revisión de la literatura utilizando las principales bases de datos como PUBMED, EMBASE, CINAHL (EBSCO), Google académico, LILACS, Cochrane, ProQuest, disertaciones y tesis, obteniendo 3934 referencias, aplicando los criterios de inclusión y exclusión se seleccionaron 7 experimentos clínicos aleatorizados controlados. Utilizando la valoración de riesgo de sesgos de Cochrane, se evaluó la calidad de los estudios. El análisis estadístico se realizó con REVMAN 5.2. Con un total de 5.552 sujetos, se encontró desarrollo de cáncer gástrico en 55 (2,41%) de 2278 pacientes a quienes se erradicó el H. pylori y en 96 (4,22%) de 2.272 a quienes no se les erradicó, RR: 0,57 (IC= 0,42-0,79). El tiempo de seguimiento osciló entre 3 y 15 años. El análisis de heterogeneidad (Chi cuadrado) tuvo un valor de p no significativo (p= 0,48) confirmando la NO presencia heterogeneidad, permitiendo el metanálisis. Con el gráfico de embudo (Funnel Plot), se descartó el sesgo de publicación y el análisis de sensibilidad no mostró cambios significativos. En conclusión, este estudio sugiere que la erradicación del H. pylori disminuye el riesgo de cáncer gástrico, particularmente en poblaciones de alto riesgo, con una calidad de evidencia moderada. Recomendando en la práctica, la terapia de erradicación de H. pylori como medida de prevención.

The aim of this systematic review and meta-analysis is to determine the efficacy of eradicating Helicobacter pylori for prevention of gastric cancer. We conducted a literature review using major databases including PUBMED, EMBASE, CINAHL (EBSCO), Google Scholar, LILACS, Cochrane, ProQuest Dissertations and Theses. Seven experiments were selected out of the 3,934 references obtained by applying our inclusion and exclusion criteria. All seven were randomized controlled trials. The quality of the studies was assessed with the Cochrane assessment of risk of bias. Statistical analysis was performed with REVMAN 5.2. Out of a total of 5,552 subjects, 55 (2.41%) of the 2,278 patients who had had H. pylori eradicated developed gastric cancer, but 96 (4.22%) of the 2,272 patients who had not had the bacteria eradicated developed gastric cancer (RR: 0.57, CI = 0.42 to 0.79). Follow-up time ranged from 3 to 15 years. The analysis of heterogeneity (Chi square) had a non-significant p value (p = 0.48) confirming the absence of heterogeneity and allowing the meta-analysis. Funnel Plot analysis was used to discard publication bias, and the sensitivity analysis showed no significant changes. In conclusion, this study suggests that eradication of H. pylori reduces the risk of gastric cancer, particularly in high-risk populations with medium quality evidence. We recommend the practice of using eradicate of H. pylori as a preventive measure.

Relationship between recurrence of Barrett esophagus and Helicobacter pylori eradication therapy in the elderly / 中华老年医学杂志

Objective To investigate the relationship between the recurrence of Barrett esophagus (BE) and Helicobacter pylori (Hp) eradication therapy, according to endoscopic follow-up outcomes in the elderly patients with BE after endoscopic argon plasma coagulation (APC). Methods A total of 201 elderly patients were enrolled to be treated with APC, including 53 patients without Hp infection (control group) and 148 cases with Hp infection (infection group), then the infection group was randomly divided into two groups: infection group A (n=74) and infection group B (n=74). After APC, all patients were given acid suppression therapy with omeprazole infusion 40 mg twice daily for 7 days, then omeprazole capsules 20 mg twice a day orally, the overall time was 2months. The patients in infection group B received Hp eradication therapy with two of the following three kinds of antibiotics for 2 weeks: amoxicillin 500 mg twice a day, clarithromycin 500 mg twice a day and tinidazole 500 mg twice a day. All patients received reexamination of endoscopy and pathology, and underwent 24-hour esophageal pH test 1, 3, 6, 12 and 24 months after treatment.Results By APC treatment for an average of 2.4 times (1-3 times), 1 month after treatment, all BE epithelium disappeared and stratified squamous epithelium was repaired completely. Reflux esophagitis (RE) and BE in some cases were found in 3 groups 3 months after therapy. The relapse incidence of RE was significantly increased at 6 months after therapy [control group: 22.6%, infection group A:12.2o%and infection group B: 17. 6%, t = 2.21, 2.17 and 2.30,P＜0. 05]. At 12 months after therapy, the relapse incidence of BE was significantly increased [control group: 22.6%, infection group A: 18.9% and infection group B: 23.0%, t=2.11, 2.19 and 2.32, P＜0. 05]. All patients presented pathological gastro-esophageal reflux (DeMeester index＞14.72) before treatment. At 1 month after therapy, all patients returned to normal DeMeester index[control group: 14.5, infection group A: 15.2 and infection group B: 12.0, t=2.09, 2.22 and 2.15, P＜0. 05]. At 6 months after treatment, DeMeester index increased (t=2.29, 2.33 and 2.14, P＜0.05). But there were no significant differences among 3 groups (P＞0. 05). Conclusions The elderly BE patients with HP infection in gastric antrum can receive APC treatment plus Hp eradication treatment, but it has no significant effect on long-term prognosis for BE patients. APC treatment can completely remove BE epithelium, long-term acid suppression therapy may delay recurrence of BE.

The Change of Cyclooxygenase-2 and Inducible Nitric Oxide Synthase in the Gastric Mucosa One Year after Eradication of Helicobacter pylori / 대한소화기학회지

BACKGROUND/AIMS: The cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS), the proteins that have the role in the gastric carcinogenesis, are stimulated by H. pylori infection in the gastric mucosa. The aim of this study was to evaluate the expression of COX-2 and iNOS proteins one year after the eradication of H. pylori. METHODS: Gastric antral mucosa from fifty eight patients with chronic gastritis who were all infected with H. pylori was examined for the expression of COX-2 and iNOS proteins before and one year after the eradication of H. pylori by immunohistochemical stain. RESULTS: COX-2 and iNOS proteins were expressed in the epithelial cells and interstitial inflammatory cells of gastric mucosa. Percent expressions of COX-2 and iNOS were significantly decreased one year after the eradication in the patients with cured infection, but not in those having persistent H. pylori. COX-2 and iNOS expressions were well correlated with H. pylori density, acute and chronic inflammation of gastric mucosa. CONCLUSIONS: The eradication of H. pylori can decrease the expression of COX-2 and iNOS in the gastric mucosa in long-term period. This seems to be due to the removal of H. pylori itself and related regression of gastric inflammation.

A Case of Primary B Cell Mucosa-associated Lymphoid Tissue Lymphoma Presenting as a Solitary Rectal Mass / 대한소화기내시경학회지

Primary extranodal B cell lymphoma of mucosa- associated lymphoid tissue (MALT) can develop in diverse anatomic locations such as the stomach, salivary gland, thyroid, lung, and breast. Its distribution in the GI tract is as follows: 50~60% in the stomach, 20~30% in the small intestine and ileocecal area and 10% in the colorectal area. Although autoimmune and infectious diseases are known as the main etiologies, H. pylori infection has been clearly shown to play a causative role in lymphomagenesis, especially in the stomach. H. pylori eradication therapy only can induce disease remission nearly in 80% of the cases of gastric MALT lymphoma. However, there is lack of evidence for the extragastric area. In this case, a 71-year-old woman with low abdominal pain was diagnosed as having a rectal MALT lymphoma that was noted as a solitary rectal mass in a colonoscopic examination. Remission induction was commenced by H. pylori eradication and radiation therapy.

A Case of Russell Body Gastritis Associated with Helicobacter pylori Infection / 대한소화기내시경학회지

Russell body gastritis is a very rare disease with an uncertain cause. The disease is often misdiagnosed as xanthoma, signet ring cell carcinoma, MALT lymphoma and plasmacytoma. Russell body gastritis is characterized by the polyclonic nature of immunoglobulin and usually tests positive to the kappa and lambda light chains. It is different from a Mott cell tumor, which shows monoclonal nature of immunoglobulin. Until now, few cases have been reported and most were associated with a Helicobacter pylori infection. We encountered a case of Russell body gastritis associated with a Helicobacter pylori infection, which showed complete improvement after eradicating the Helicobacter pylori infection. We report this case with review of the relevant literature.

Effect of smoking on failure of H. pylori therapy and gastric histology in a high gastric cancer risk area of Colombia / Efecto del tabaquismo en la falla al tratamiento anti-H. pylori y en la histología gástrica en una zona de alto riesgo de cáncer gástrico en Colombia

It has been proposed that eradication of Helicobacter pylori infection is a sound strategy for gastric cancer prevention. Several factors including smoking have been associated to treatment failure rates. This study aimed to evaluate the smoking effect on the efficacy of H. pylori therapy, as well as on the histological parameters in the gastric mucosa from subjects from a high gastric cancer risk area. Two-hundred-sixty-four Colombian subjects with gastric precancerous lesions who participated in a chemoprevention trial, received anti- H. pylori treatment at baseline and had data recorded on cigarette use, were included in this study. A detailed histopathological assessment of the gastric mucosa was performed in biopsies taken before any intervention. H. pylori eradication was assessed in gastric biopsies at 36 months post-treatment. The overall eradication rate was 52.3%; rates of 41.3% and 57.1% were observed for active-smokers and non-smokers, respectively. Multivariate logistic regression analysis showed that smokers had a 2-fold higher probability of failure in Helicobacter pylori eradication than non-smokers (OR: 2.0; 95% CI: 1.01-3.95). At baseline, activesmokers had a higher score of intestinal metaplasia compared to non-smokers. In the corpus mucosa, active-smokers showed lower scores of H. pylori density, total inflammation, neutrophil infiltration, and mucus depletion than non-smokers. In the antrum, no significant differences were observed between active-smokers and non-smokers. In summary, in patients who smoked, H. pylori treatment was less effective. Smoking cessation may benefit H. pylori eradication rates.

La erradicación del Helicobacter pylori ha sido propuesta como medida promisoria en la prevención del cáncer gástrico. Varios factores, incluyendo el tabaquismo, se asocian con la falla del tratamiento. El objetivo de este estudio fue evaluar el efecto del tabaquismo en la eficacia del tratamiento anti-H. pylori y en la histología gástrica en residentes de una zona de alto riesgo de cáncer gástrico. Este estudio incluyó 264 sujetos colombianos con lesiones gástricas preneoplásicas que participaron en un estudio de quimioprevención, recibieron tratamiento anti-H. pylori al ingreso, y proveyeron información sobre tabaquismo. Se realizó un detallado análisis histopatológico en las biopsias colectadas al ingreso. La erradicación de la infección fue evaluada en las biopsias gástricas a los 36 meses post-tratamiento. El porcentaje general de erradicación fue de 52.3%, con proporciones de 41.3% y 57.1% en fumadores activos y no fumadores, respectivamente. El análisis de regresión logística múltiple mostró que el riesgo de presentar falla al tratamiento fue doble en fumadores en comparación con los no fumadores (OR: 2.0; 95% CI: 1.01-3.95). Los fumadores presentaron un mayor índice de metaplasia intestinal comparado con los no fumadores. En la mucosa del cuerpo gástrico los fumadores mostraron menores índices de colonización por H. pylori, inflamación total, infiltración de neutrófilos y depleción de moco que los no fumadores. En el antro no se observaron diferencias significacomtivas entre ambos grupos. En conclusión, el tratamiento anti-H. pylori fue menos efectivo en sujetos fumadores. La cesación del consumo de tabaco puede beneficiar las tasas de erradicación del H. pylori.

The Clinical Efficacy of Helicobacter pylori Eradication in Patients with Helicobacter pylori-positive Chronic Thrombocytopenic Purpura / 대한혈액학회지

BACKGROUND: Helicobacter pylori (H. pylori) have been implicated in the pathogenesis of some autoimmune diseases including idiopathic thrombocytopenic purpura (ITP). Several studies have recently shown a high prevalence of H. pylori infection in patients with ITP, and reported platelet recovery after bacterial eradication therapy. The prevalence of H. pylori infection, and the effect of its eradication, in Korean patients with chronic ITP were investigated. METHODS: The study included 35 patients, from 8 hospitals, with chronic ITP. The H. pylori infection was assessed by the urea breath test, rapid urease test or microbial culture. H. pylori eradication was performed with the amoxicillin, clarithromycin and omeprazole regimen for 7 days, or the bismuth, metronidazole and tetracycline regimen for 10 days. Eradication was assessed by urea breath test 4 weeks after treatment. Platelet counts were monitored serially after the end of treatment. RESULTS: Thirty five patients with chronic ITP were evaluated, including 12 males and 23 females, with a median age of 57 years (range 30~79). The median platelet count before eradication was 23,000/microliter (range 4,000~66,000/microliter). Sixteen patients had previously undergone a splenectomy. The H. pylori infection was found in 23 (65%) of the 35 patients. Eradication, was performed in 21 patients, and 6 (28.5%) had a significant increase in their platelet counts after both 2 weeks and 2 months. The median response duration was 7.6 months, ranging from 1~27 months. CONCLUSION: This study confirmed the efficacy of H. pylori eradication in increasing the platelet count in adult chronic ITP patients. The investigation and eradication of H. pylori infection in ITP patients must be considered a simple and inexpensive tool in management of this chronic disease.