Skip to main content
SpringerLink
Log in

Helicobacter pylori Infection and Idiopathic Thrombocytopenic Purpura

  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

A treatment strategy for idiopathic thrombocytopenic purpura (ITP) is considered with the aim of cure or management of the bleeding tendency. In 1998, Gasbarrini et al reported a high prevalence of Helicobacter pylori infection in patients with ITP and showed that platelet recovery occurred after eradication therapy in most cases. Since then, many studies were performed to evaluate eradication therapy. This article discusses the incidence of H pylori infection in ITP, characteristic clinical features in H pylori-positive ITP, the effectiveness of eradication on platelet count increase, and the mechanisms of development of ITP by H pylori infection. Overall, there was a positive association between H pylori infection and ITP, and eradication of bacterium was accompanied by a significant increase in platelet counts in more than 50% of H pylori-positive ITP cases. These findings suggest that H pylori infection is involved in the mechanisms of thrombocytopenia in most cases of ITP in middle-aged and older patients.This approach could be beneficial to some ITP patients, but there were some uncertainties raised. To confirm the effectiveness of eradication therapy in H pylori- positive ITP, prospective studies conducted in several countries with a new treatment protocol are required, with a large number of ITP cases and longer follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet. 1997;349:1531–1536.

    Article  PubMed  CAS  Google Scholar 

  2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med. 2002;346:995–1008.

    Article  PubMed  Google Scholar 

  3. Kuwana M, Kaburaki J, Kitasato H, et al. Immunodominant epitopes on glycoprotein IIb-IIIa recognized by autoreactive T cells in patients with immune thrombocytopenic purpura. Blood. 2001;98:130–139.

    Article  PubMed  CAS  Google Scholar 

  4. Gasbarrini A, Franceschi F, Tartaglione R, Landolfi R, Pola P, Gasbarrini G. Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori. Lancet. 1998;352:878.

    Article  CAS  PubMed  Google Scholar 

  5. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002;347:1175–1186.

    Article  PubMed  CAS  Google Scholar 

  6. Gasbarrini A, Carloni E, Gasbarrini G, Menard A. Helicobacter pylori and extra gastric diseases-other helicobacters. Helicobacter. 2003;8:68–76.

    Article  PubMed  Google Scholar 

  7. De Luis DA, Varela C, de la Calle H, et al. Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. J Clin Gastroenterol. 1998;26:259–263.

    Article  PubMed  Google Scholar 

  8. Figura N, Giordano N, Burroni D, et al. Sjogrens syndrome and Helicobacter pylori infection. Eur J Gastroenterol Hepatol. 1994;6:321–322.

    Google Scholar 

  9. Zentilin P, Savarino V, Gamero A, Accardo S, Serino B. Is Helicobacter pylori infection a risk factor for disease severity in rheumatoid arthritis? Gastroenterology. 1999;116:503–504.

    Article  PubMed  CAS  Google Scholar 

  10. Emillia G, Longo G, Luppi M, et al. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood. 2001;97:812–814.

    Article  Google Scholar 

  11. 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. Brit J Haematol. 2002;118:584–588.

    Article  Google Scholar 

  12. 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;77:188–191.

    Article  PubMed  CAS  Google Scholar 

  13. 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;77:239–244.

    Article  PubMed  Google Scholar 

  14. Asaka M, Kimura T, Kudo M, et al. Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population. Gastroenterology. 1992;102:760–766.

    Article  PubMed  CAS  Google Scholar 

  15. Rajantie J, Klemola T. Helicobacter pylori and idiopathic thrombocytopenic purpura in children. Blood. 2003;101:1660.

    Article  CAS  PubMed  Google Scholar 

  16. 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;92:1153–1157.

    Article  CAS  PubMed  Google Scholar 

  17. Michel M, Cooper N, Christelle J, Frissora C, Bussel JB. Does Helicobacter pylori initiate or perpetuate immune thrombocytopenic purpura? Blood. 2004;103:890–896.

    Article  PubMed  CAS  Google Scholar 

  18. Ando T, Tsuzuki T, Mizuno T, et al. Characteristics of Helicobacter pylori-induced gastritis and the effect of H. pylori eradication in patients with chronic idiopathic thrombocytopenic purpura. Helicobacter. 2004;9:443–52.

    Article  PubMed  Google Scholar 

  19. Emilia G, Luppi M, Morselli M, Potenza L, Apollo ND, Torelli G. Helicobacter pylori infection and idiopathic thrombocytopenic purpura. Brit J Haematol. 2002;118:1198–1199.

    Article  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. Brit J Haematol. 2001;115:1002–1003.

    Article  CAS  Google Scholar 

  21. Michel M, Khellaf M, Desforges L, et al. Autoimmune thrombocytopenic purpura and Helicobacter pylori infection. Arch Intern Med. 2004;162:1033–1035.

    Article  Google Scholar 

  22. Takahashi T, Yujiri T, Shinohara K, et al. Molecular mimicry by Helicobacter pylori Cag A protein may be involved in the pathogenesis of pylori-associated chronic idiopathic thrombocytopenic purpura. Brit J Haematol. 2004;124:91–96.

    Article  CAS  Google Scholar 

  23. 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;164:1904–1907.

    Article  PubMed  Google Scholar 

  24. Kurtoglu E, Kayacetin E, Ulger A. Helicobacter pylori infection in patients with autoimmune thrombocytopenic purpura. World J Gastroenterol. 2004;10:2113–2115.

    Article  PubMed  PubMed Central  Google Scholar 

  25. 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;81:162–168.

    Article  PubMed  Google Scholar 

  26. Segal BM, Klinman DM, Shevach EM. Microbial products induce autoimmune disease by an IL-12 dependent pathway. J Immunol. 1997;158:5087–5090.

    PubMed  CAS  Google Scholar 

  27. Marrack P, Kappler J, Kotzin BL. Autoimmune disease: why and where it occurs. Nature Med. 2001;7:899–905.

    Article  PubMed  CAS  Google Scholar 

  28. Yuceyar H, Saruc M, Kokuludag A, Terzioglu E, Goksel G, Isisag A. The systemic cellular immune response in the Helicobacter pyloriassociated duodenal ulcer and chronic antral gastritis. Hepatogastroenterology. 2002;49:1177–1179.

    PubMed  Google Scholar 

  29. Pellicano R, Touscoz GA, Smedile A, et al. Prevalence of nonorgan- specific autoantibodies in patients suffering from duodenal ulcer with and without Helicobacter pylori infection. Dig Dis Sci. 2004;49:395–398.

    Article  PubMed  CAS  Google Scholar 

  30. Amedei A, Bergman MP, Appelmelk BJ, et al. Molecular mimicry between Helicobacter pylori antigens and H+, K+ -adenosine triphosphatase in human gastric autoimmunity. J Exp Med. 2003;198:1147–1156.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  31. Rad R, Gerhard M, Lang R, et al. The Helicobacter pylori blood group antigen-binding adhesin facilitates bacterial colonization and augments a nonspecific immune response. J Immunol. 2002;168:3033–3041.

    Article  PubMed  CAS  Google Scholar 

  32. McCrae KR. Helicobacter pylori and ITP: many questions, few answers. Blood. 2004;103:751–752.

    Google Scholar 

  33. Takahashi T,Yujiri T, Tanizawa Y. Helicobacter pylori and chronic ITP: the discrepancy in the clinical responses to eradication therapy might be due to difference in the bacterial strains. Blood. 2004;104:594.

    Article  PubMed  CAS  Google Scholar 

  34. Byrne MF, Kerrigan SW, Corcoran PA, et al. Helicobacter pylori binds von Willebrand factor and interacts with GPIb to induce platelet aggregation. Gastroenterology. 2003;124:1846–1854.

    Article  PubMed  CAS  Google Scholar 

  35. Veneri D, Gottardi M, Guizzardi E, Zanuso C, Krampera M, Franchini M. Idiopathic thrombocytopenic purpura, Helicobacter pylori infection, and HLA class II alleles. Blood. 2002;100:1925–1926.

    Article  PubMed  CAS  Google Scholar 

  36. Magnusson PKE, Enroth H, Eriksson I, et al. Gastric cancer and human leukocyte antigen: distinct DQ and DR alleles are associated with development of gastric cancer and infection by Helicobacter pylori. Cancer Res. 2001;61:2684–2689.

    PubMed  CAS  Google Scholar 

  37. Franchini M, Veneri D. Helicobacter pylori infection and immune thrombocytopenic purpura: an update. Helicobacter. 2004;9:342–346.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Graduate School of Biomedical Science, Department of Pharmacotherapy, Division of Hemato/Oncology, Hiroshima University, 1-2-3 Kasumi Minami-ku, Hiroshima, Japan

    Kingo Fujimura

Authors
  1. Kingo Fujimura
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kingo Fujimura.

About this article

Cite this article

Fujimura, K. Helicobacter pylori Infection and Idiopathic Thrombocytopenic Purpura. Int J Hematol 81, 113–118 (2005). https://doi.org/10.1532/IJH97.04161

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1532/IJH97.04161

Key words

Search

Navigation