Background/Purpose: Helicobacter pylori (H. pylori) infection has been linked to pathogenesis of autoimmune disease including chronic idiopathic thrombocytopenic purpura (ITP). Prior studies showed platelet counts have improved after eradication of H. pylori in some patients with ITP. To clarify the role of H. pylori in chronic thrombocytopenia and its response to treatment in association with autoantibody status.

Methods: Medical records from 2002-2012 were reviewed at Okinawa Chubu Hospital to locate patients > 18 years old with chronic ITP (platelet < 100,000 /mm³for > 12 months). After exclusion of acute ITP and secondary chronic thrombocytopenia, 49 patients were included. We recorded antinuclear antibody (ANA), antiphospholipid antibody (APLA) and H. pylori status. Treatment for H. pylori infection was administered to patients with positive H. pylori detected by breath test. Platelet count was monitored at least for one year after eradication of H. pylori.

Results: Median age was 44 years (range, 18-86); 39/49 subjects were female (80%). ANA or APLA was positive but H. pylori was negative in 25/49 (50%); H. pylori infection was present in 15/49 (31%), and both H. pylori and autoantibody were positive in 10/49 (20%). All patients with H. pylori infection were treated with antibiotics. Eradication failed to improve platelet counts in 10/10 cases with positive ANA or APLA. Among patients with H. pylori without autoantibodies, 3/5 responded with increased platelet counts and 2/5 did not. The overall rate of positive autoantibody in non-responders was therefore 10/12 (83%), and zero in responders.

Conclusion: Among patients with chronic ITP and H. pylori infection, refractory thrombocytopenia after eradication may identify a subset of patients with positive autoantibody. Immunological response to H. pylori may be associated with poor response rate to antibiotic treatment in patients with concomitant ITP and H. pylori infection.

---

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/response-to-h-pylori-treatment-and-autoantibody-in-chronic-thrombocytopenia/