Effect of Helicobacter pylori eradication on platelet count in patients with chronic idiopathic thrombocytopenic purpura

This study was carried out on 40 patients [14 men and 26 women] have Chronic Idiopathic Thrombocytopenic Purpura [cITP]; their ages ranged from 48 to 70 years in males and 46-62 years in females, mean age +/- SD[5 7.5 +/- 11.4 and 56.6 +/- 8] years respectively among those referred from the Outpatients clinic and inpatients Department of general and Tropical Medicine Departments, Faculty of Medicine, Al-Azhar University Hospitals, from April 2007 to July 2009 . Results showed: Of 40 cITP patients, H.pylori infection was found in 25 [62.5%] patients were noted between infected men [6 infected versus 8 uninfected] and women [19 infected versus 7 uninfected], no significant differences were found as regards ; age and gender, clinical factors between the responders amid the non responders. The eradication of H.pylori was achieved in 76.9% [10 of 13] of these patients. The platelet recovery was significantly different between the eradication group 61.5% [8 of 13] and the non-eradication group [zero% . 0 of 12].The eradication of H. pylori infection in patients with cITP was associated with a platelet response in 46.1% [6 of 13] in the eradication group [4 Complete Response and 2 Partial Response] and zero% in the non-eradication group [P<0.01]. The platelet response was also significantly more common in patients with infection sustained by CagA-positive strains of H .pylori [P=0.04]. H. pylori virulence factors and the urease activity were not associated with the response. cITP H. pylori positive patients showed significantly lower platelet counts compared to H. pylori negative patients. H. pylori eradication in patients with cITP is effective in increasing platelet count. The titers of anti-CagA antibodies in the responders were significantly higher than those in the non responders [p=0.04]

Hemodynamic predictors for acute variceal hemorrhage in cirrhotic patients

In cirrhotic patients once varices occur they tend to progressively increase in size and the risk of bleeding has been shown to be related to varix size and appearance as well as the severity of the underling liver disease. About 30% of patients with varices will experience bleeding. This work was a trial to study if the portal hemodynamic parameters can be considered as predictors for the onset of acute variceal bleeding in cirrhotic patients? And to study the possible correlation of these predictors to the clinical and laboratory prognostic indicators. The study was conducted on 50 patients with liver cirrhosis, 40 of them had acute variceal bleeding [group 1], and 10 with non-bleeding esophageal varices [group l]. All patients were subjected to thorough history taking, clinical examination, and a series of investigations including upper gastrointestinal endoscopy, laboratory investigations [complete blood picture, some liver function tests, viral markers, serum creatinine], and radiological assessment [abdominal ultrsound, Dopuler study of the portal venous system, and portal angiography]. Group I patients had more worsening of Child-Pugh score with B/C classes [75%] than group Il [30%]. Lower platelet count [p=0.001], higher serum bilirubin [P=0.007], and pro-longed prothrombin time [p=0.007] were found in-group I patients. Both North Italian Endoscopic Club index and the Endoscopic Prognostic Index exhibited significant importance in group I patients [p=0.001]. Significant increase in portal vein diameter [p=0.006], in its cross sectional area [p=0.05], and in portal vein flow [p-0.006], in free pressure [p=0.001], wedged hepatic vein pressure [p=0.001], and hepatic vein pressure gradient [p=0.003] were found in group I. Also, in group I patients, hepatic vein pressure gradient was found to be positively correlated with ascites, splenic size, and prolonged prothrombin time, but, negatively correlated with platelet count

In Conclusion: in the presence of cirrhosis with non-bleeding esophageal varices, the clinician has to evaluate the risk for bleeding. In those patients, non-invasive hemodynamic study of the portal circulation by endoscopic prognostic index and/ or Doppler study of the portal venous system can be considered as non-invasive tools for prediction of variceal bleeding and would help to enable better understanding of this condition overall. Furthermore, these parameters could replace the invasive measurements of portal vein pressure and hepatic vein pressure gradient as predictors for variceal bleeding in cirrhotic patients