Skip to main content

Helicobacter pylori (H. pylori) Eradication

  • Chapter
  • First Online:
Autoimmune Thrombocytopenia

Abstract

In 1998, Gasbarrini et al. reported that eradication therapy for Helicobacter pylori (H. pylori) increased platelet counts in most H. pylori-positive immune thrombocytopenia (ITP) patients. A large number of retrospective and prospective studies have since been performed in order to evaluate the efficacy of eradication therapy. A positive relationship was reported between ITP and H. pylori infection, and the eradication of H. pylori resulted in a significant increase in platelet counts in more than 50% of eradication-successful ITP cases. These results suggest that H. pylori infection is involved in the mechanisms underlying thrombocytopenia.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet. 1997;349(9064):1531–6. doi:10.1016/S0140-6736(96)12118-8.

    Article  CAS  PubMed  Google Scholar 

  2. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. New Engl J Med. 2002;346(13):995–1008. doi:10.1056/NEJMra010501.

    Article  PubMed  Google Scholar 

  3. Olsson B, Andersson PO, Jernas M, Jacobsson S, Carlsson B, Carlsson LM, et al. T-cell-mediated cytotoxicity toward platelets in chronic idiopathic thrombocytopenic purpura. Nat Med. 2003;9(9):1123–4. doi:10.1038/nm921.

    Article  CAS  PubMed  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(9131):878. doi:10.1016/S0140-6736(05)60004-9.

    Article  CAS  PubMed  Google Scholar 

  5. Suerbaum S, Michetti P. Helicobacter pylori infection. New Engl J Med. 2002;347(15):1175–86. doi:10.1056/NEJMra020542.

    Article  CAS  PubMed  Google Scholar 

  6. Zentilin P, Savarino V, Garnero A, Accardo S, Seriolo B. Is Helicobacter pylori infection a risk factor for disease severity in rheumatoid arthritis? Gastroenterology. 1999;116(2):503–4.

    Article  CAS  PubMed  Google Scholar 

  7. de Luis DA, Varela C, de La Calle H, Canton R, de Argila CM, San Roman AL, et al. Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. J Clin Gastroenterol. 1998;26(4):259–63.

    Article  PubMed  Google Scholar 

  8. Radic M. Role of Helicobacter pylori infection in autoimmune systemic rheumatic diseases. World J Gastroenterol. 2014;20(36):12839–46. doi:10.3748/wjg.v20.i36.12839.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Malfertheiner P, Megraud F, O’Morain CA, Atherton J, Axon AT, Bazzoli F, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence Consensus Report. Gut. 2012;61(5):646–64. doi:10.1136/gutjnl-2012-302084.

    Article  CAS  PubMed  Google Scholar 

  10. Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, et al. The Toronto consensus for the treatment of Helicobacter pylori infection in adults. Gastroenterology. 2016;151(1):51–69.e14. doi:10.1053/j.gastro.2016.04.006.

    Article  PubMed  Google Scholar 

  11. Murakami K, Sakurai Y, Shiino M, Funao N, Nishimura A, Asaka M. Vonoprazan, a novel potassium-competitive acid blocker, as a component of first-line and second-line triple therapy for Helicobacter pylori eradication: a phase III, randomised, double-blind study. Gut. 2016;65(9):1439–46. doi:10.1136/gutjnl-2015-311304.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Emilia G, Longo G, Luppi M, Gandini G, Morselli M, Ferrara L, et al. Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood. 2001;97(3):812–4.

    Article  CAS  PubMed  Google Scholar 

  13. Veneri D, Franchini M, Gottardi M, D’Adda M, Ambrosetti A, Krampera M, et al. Efficacy of Helicobacter pylori eradication in raising platelet count in adult patients with idiopathic thrombocytopenic purpura. Haematologica. 2002;87(11):1177–9.

    PubMed  Google Scholar 

  14. Kohda K, Kuga T, Kogawa K, Kanisawa Y, Koike K, Kuroiwa G, et al. Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura. Br J Haematol. 2002;118(2):584–8.

    Article  PubMed  Google Scholar 

  15. Hashino S, Mori A, Suzuki S, Izumiyama K, Kahata K, Yonezumi M, et al. Platelet recovery in patients with idiopathic thrombocytopenic purpura after eradication of Helicobacter pylori. Int J Hematol. 2003;77(2):188–91.

    Article  CAS  PubMed  Google Scholar 

  16. Ando K, Shimamoto T, Tauchi T, Ito Y, Kuriyama Y, Gotoh A, 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(3):239–44.

    Article  PubMed  Google Scholar 

  17. Takahashi T, Yujiri T, Shinohara K, Inoue Y, Sato Y, Fujii Y, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004;124(1):91–6.

    Article  CAS  PubMed  Google Scholar 

  18. Ando T, Tsuzuki T, Mizuno T, Minami M, Ina K, Kusugami K, 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(5):443–52. doi:10.1111/j.1083-4389.2004.00261.x.

    Article  PubMed  Google Scholar 

  19. Veneri D, Krampera M, Franchini M. High prevalence of sustained remission of idiopathic thrombocytopenic purpura after Helicobacter pylori eradication: a long-term follow-up study. Platelets. 2005;16(2):117–9. doi:10.1080/09537100400015153.

    Article  CAS  PubMed  Google Scholar 

  20. Stasi R, Rossi Z, Stipa E, Amadori S, Newland AC, Provan D. Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura. Am J Med. 2005;118(4):414–9. doi:10.1016/j.amjmed.2004.09.014.

    Article  PubMed  Google Scholar 

  21. Fujimura K, Kuwana M, Kurata Y, Imamura M, Harada H, Sakamaki H, 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(2):162–8.

    Article  PubMed  Google Scholar 

  22. Emilia G, Luppi M, Zucchini P, Morselli M, Potenza L, Forghieri F, et al. Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles. Blood. 2007;110(12):3833–41. doi:10.1182/blood-2006-12-063222.

    Article  CAS  PubMed  Google Scholar 

  23. Asahi A, Nishimoto T, Okazaki Y, Suzuki H, Masaoka T, Kawakami Y, et al. Helicobacter pylori eradication shifts monocyte Fcgamma receptor balance toward inhibitory FcgammaRIIB in immune thrombocytopenic purpura patients. J Clin Invest. 2008;118(8):2939–49. doi:10.1172/JCI34496.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Jarque I, Andreu R, Llopis I, De la Rubia J, Gomis F, Senent L, et al. Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2001;115(4):1002–3.

    Article  CAS  PubMed  Google Scholar 

  25. Michel M, Khellaf M, Desforges L, Lee K, Schaeffer A, Godeau B, et al. Autoimmune thrombocytopenic purpura and Helicobacter pylori infection. Arch Intern Med. 2002;162(9):1033–6.

    Article  PubMed  Google Scholar 

  26. Michel M, Cooper N, Jean C, Frissora C, Bussel JB. Does Helicobacter pylori initiate or perpetuate immune thrombocytopenic purpura? Blood. 2004;103(3):890–6. doi:10.1182/blood-2003-03-0900.

    Article  CAS  PubMed  Google Scholar 

  27. Ahn ER, Tiede MP, Jy W, Bidot CJ, Fontana V, Ahn YS. Platelet activation in Helicobacter pylori-associated idiopathic thrombocytopenic purpura: eradication reduces platelet activation but seldom improves platelet counts. Acta Haematol. 2006;116(1):19–24. doi:10.1159/000092343.

    Article  PubMed  Google Scholar 

  28. Payandeh M, Sohrabi N, Zare ME, Kansestani AN, Hashemian AH. Platelet count response to Helicobacter pylori eradication in Iranian patients with idiopathic thrombocytopenic purpura. Mediterr J Hematol Infect Dis. 2012;4(1):e2012056. doi:10.4084/MJHID.2012.056.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Suvajdzic N, Stankovic B, Artiko V, Cvejic T, Bulat V, Bakrac M, et al. Helicobacter pylori eradication can induce platelet recovery in chronic idiopathic thrombocytopenic purpura. Platelets. 2006;17(4):227–30. doi:10.1080/09537100500462487.

    Article  CAS  PubMed  Google Scholar 

  30. Sayan O, Akyol Erikci A, Ozturk A. The efficacy of Helicobacter pylori eradication in the treatment of idiopathic thrombocytopenic purpura—the first study in Turkey. Acta Haematol. 2006;116(2):146–9. doi:10.1159/000093648.

    Article  PubMed  Google Scholar 

  31. Tsumoto C, Tominaga K, Okazaki H, Tanigawa T, Yamagami H, Watanabe K, et al. Long-term efficacy of Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura: 7-year follow-up prospective study. Ann Hematol. 2009;88(8):789–93. doi:10.1007/s00277-008-0667-5.

    Article  CAS  PubMed  Google Scholar 

  32. Kikuchi T, Kobayashi T, Yamashita T, Ohashi K, Sakamaki H, Akiyama H. Eight-year follow-up of patients with immune thrombocytopenic purpura related to H. pylori infection. Platelets. 2011;22(1):61–4. doi:10.3109/09537104.2010.515272.

    Article  CAS  PubMed  Google Scholar 

  33. Franchini M, Cruciani M, Mengoli C, Pizzolo G, Veneri D. Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura: a systematic review and meta-analysis. J Antimicrob Chemother. 2007;60(2):237–46. doi:10.1093/jac/dkm195.

    Article  CAS  PubMed  Google Scholar 

  34. Stasi R, Sarpatwari A, Segal JB, Osborn J, Evangelista ML, Cooper N, et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood. 2009;113(6):1231–40. doi:10.1182/blood-2008-07-167155.

    Article  CAS  PubMed  Google Scholar 

  35. Arnold DM, Bernotas A, Nazi I, Stasi R, Kuwana M, Liu Y, et al. Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review. Haematologica. 2009;94(6):850–6. doi:10.3324/haematol.2008.005348.

    Article  PubMed  PubMed Central  Google Scholar 

  36. British Committee for Standards in Haematology General Haematology Task Force. Guidelines for the investigation and management of idiopathic thrombocytopenic purpura in adults, children and in pregnancy. Br J Haematol. 2003;120(4):574–96.

    Article  Google Scholar 

  37. George JN. Management of patients with refractory immune thrombocytopenic purpura. J Thrombosis Haemost. 2006;4(8):1664–72. doi:10.1111/j.1538-7836.2006.02013.x.

    Article  CAS  Google Scholar 

  38. Stasi R, Provan D. Helicobacter pylori and chronic ITP. Hematology Am Soc Hematol Educ Program. 2008:206–11. doi:10.1182/asheducation-2008.1.206.

  39. Neunert C, Lim W, Crowther M, Cohen A, Solberg Jr L, Crowther MA, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood. 2011;117(16):4190–207. doi:10.1182/blood-2010-08-302984.

    Article  CAS  PubMed  Google Scholar 

  40. Fujimura K, Miyakawa Y, Kurata Y, Kuwana M, Tomiyama Y, Murata M. Reference guide for management of adult idiopathic thrombocytopenic purpura (ITP) 2012 version. Rinsho Ketsueki. 2012;53(4):433–42.

    PubMed  Google Scholar 

  41. Kuwana M. Helicobacter pylori-associated immune thrombocytopenia: clinical features and pathogenic mechanisms. World J Gastroenterol. 2014;20(3):714–23. doi:10.3748/wjg.v20.i3.714.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wu Z, Zhou J, Prsoon P, Wei X, Liu X, Peng B. Low expression of FCGRIIB in macrophages of immune thrombocytopenia-affected individuals. Int J Hematol. 2012;96(5):588–93. doi:10.1007/s12185-012-1187-6.

    Article  CAS  PubMed  Google Scholar 

  43. Byrne MF, Kerrigan SW, Corcoran PA, Atherton JC, Murray FE, Fitzgerald DJ, et al. Helicobacter pylori binds von Willebrand factor and interacts with GPIb to induce platelet aggregation. Gastroenterology. 2003;124(7):1846–54.

    Article  CAS  PubMed  Google Scholar 

  44. Franceschi F, Christodoulides N, Kroll MH, Genta RM. Helicobacter pylori and idiopathic thrombocytopenic purpura. Ann Intern Med. 2004;140(9):766–7.

    Article  PubMed  Google Scholar 

  45. Maeda S, Ogura K, Yoshida H, Kanai F, Ikenoue T, Kato N, et al. Major virulence factors, VacA and CagA, are commonly positive in Helicobacter pylori isolates in Japan. Gut. 1998;42(3):338–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Perez-Perez GI, Bhat N, Gaensbauer J, Fraser A, Taylor DN, Kuipers EJ, et al. Country-specific constancy by age in cagA+ proportion of Helicobacter pylori infections. Int J Cancer. 1997;72(3):453–6.

    Article  CAS  PubMed  Google Scholar 

  47. Van Doorn LJ, Figueiredo C, Megraud F, Pena S, Midolo P, Queiroz DM, et al. Geographic distribution of vacA allelic types of Helicobacter pylori. Gastroenterology. 1999;116(4):823–30.

    Article  PubMed  Google Scholar 

  48. Wirth HP, Yang M, Peek Jr RM, Tham KT, Blaser MJ. Helicobacter pylori Lewis expression is related to the host Lewis phenotype. Gastroenterology. 1997;113(4):1091–8.

    Article  CAS  PubMed  Google Scholar 

  49. Gerhard M, Rad R, Prinz C, Naumann M. Pathogenesis of Helicobacter pylori infection. Helicobacter. 2002;7(Suppl 1):17–23.

    Article  CAS  PubMed  Google Scholar 

  50. Cines DB. ITP: time to “bug off”? Blood. 2007;110(12):3818–9. doi:10.1182/blood-2007-08-105411.

    Article  CAS  PubMed Central  Google Scholar 

  51. Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386–93. doi:10.1182/blood-2008-07-162503.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Toshiro Takafuta M.D., Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer Nature Singapore Pte Ltd.

About this chapter

Cite this chapter

Takafuta, T., Fujimura, K. (2017). Helicobacter pylori (H. pylori) Eradication. In: Ishida, Y., Tomiyama, Y. (eds) Autoimmune Thrombocytopenia . Springer, Singapore. https://doi.org/10.1007/978-981-10-4142-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-981-10-4142-6_12

  • Published:

  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-4141-9

  • Online ISBN: 978-981-10-4142-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics