Helicobacter pylori infection and thrombocytopenia: A single-institution experience in Mexico / Infección por Helicobacter pylori y trombocitopenia: Experiencia en una sola institución mexicana

The association between gastrointestinal H. pylori infection and thrombocytopenia was studied in a single institution in Mexico, over a 5-year period. In 99 individuals with H. pylori infection, the prevalence of thrombocytopenia was 14%, whereas in 23 consecutive patients with chronic refractory thrombocytopenic purpura, the prevalence of H. pylori infection was 60%, this figure being similar to that informed in the general population of Mexico (66%); the association between thrombocytopenia and H. pylori infection was not significant. In 14 patients who were found to have both thrombocytopenia and H. pylori infection, eradication treatment was given and the platelet count recovered in three. It is not still clear if detection of H. pylori infection should be routinely included in the initial workup of chronic thrombocytopenia.

Se investigó la asociación entre infección del tubo digestivo por H. pylori y trombocitopenia en una sola institución en México, en un periodo de cinco años. En 99 individuos infectados por H. pylori, la prevalencia de trombocitopenia fue de 14%; por otro lado, en 23 pacientes consecutivos con púrpura trombocitopénica crónica refractaria, la prevalencia de infección por H. pylori fue de 60%, cifra similar a la descrita para la población general de nuestro país, de alrededor de 66%; en consecuencia, la asociación entre trombocitopenia e infección por H. pylori no fue significativa. En 14 pacientes en quienes coexistieron púrpura trombocitopénica e infección por H. pylori, se administró tratamiento de erradicación de la bacteria y la cuenta de plaquetas se normalizó en tres. Los datos apoyan otras publicaciones que muestran falta de asociación entre estas variables y son insuficientes para recomendar si es prudente o no investigar la infección por H. pylori en el estudio inicial de todos los pacientes con púrpura trombocitopénica.

[Prevalence of Helicobacter pylori infection in children with chronic immune [idiopathic] thrombocytopenic purpura and evaluation of Helicobacter pylori eradication on platelet count]

Recently, the high prevalence of Helicobacter pylori infection has been reported in adult patients with chronic immune [idiopathic] thrombocytopenic purpura. Furthermore, after Helicobacter pylori eradication therapy in such patients, their platelet counts have been observed to increase, suggesting that Helicobacter pylori may be a causative agent of adults' chronic idiopathic thrombocytopenic purpura. However, there have been only a few reports of this subject in children with chronic thrombocytopenic purpura. The purpose of this study is to determine prevalence of Helicobacter pylori infection in Iranian children with chronic thrombocytopenic purpura and role of Helicobacter pylori eradication in rising platelet count of these patients. This descriptive-clinical trial study was performed in 31 children under 14 years old with chronic thrombocytopenic purpura who attended hematology ward of Mofid paediatric hospital. After determining platelet count, and filling the results patients referred to gastrointestinal ward of the hospital to perform urea breath test for evaluation of Helicobacter pylori infection, then Helicobacter pylori-infected patients who were diagnosed by this test, received eradication therapy using triple therapy regimen [containing Omeperasole, Amoxicillin and Clarithromycin] for 2 weeks and their platelet counts were recorded during the follow up period. Mean age of the patients was 8.9 +/- 3.2 years old ranging from 3.5 to 14 years old. They were 17 [54.9%] girls and 14 [45.1%] boys. Mean platelet count of the patients was 51.4 +/- 34.3x10[9] / L ranging form 125x10[9]/ L to 8x10[9] / L. Mean duration of disease in the patients was 27.7 +/- 20.2 months ranging from 7 to 96 months. Helicobacter pylori infection was found in only 4 children [12.9%] and Helicobacter pylori eradication therapy was not effective in rising platelet count to achieve complete or partial remission. Comparing Helicobacter pylori-positive and negative patients, there were no significant differences regarding their age, platelet count and duration of disease. This study shows that prevalence of Helicobacter pylori infection in children with chronic immune thrombocytopenic purpura is less than that is in adults. Furthermore, we have found that platelet count in Helicobacter pylori-positive children have not been risen after eradication therapy. We suggest that more studies in different gender groups and different zones in the world with more number of samples should be performed, especially in children in order to determine both the exact role of Helicobacter pylori's pathogenesis in developing the chronic idiopathic thrombocytopenic purpura and the effectiveness of eradication therapy in rising platelet count in these patients