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Helicobacter pylori eradication: a novel therapeutic option in chronic immune thrombocytopenic purpura
Author(s) -
Sivapathasingam Vanaja,
Harvey Michael P,
Wilson Robert B
Publication year - 2008
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2008.tb02080.x
Subject(s) - medicine , splenectomy , helicobacter pylori , thrombocytopenic purpura , immunosuppression , gastroenterology , urea breath test , platelet , surgery , immune system , immunology , helicobacter pylori infection , spleen
Objective: To determine whether Helicobacter pylori eradication is an effective treatment for Australian patients with chronic immune thrombocytopenic purpura (ITP). Design, setting and patients: Retrospective analysis of clinical records of a consecutive series of ITP patients referred to a gastrointestinal surgeon in a tertiary referral hospital for laparoscopic splenectomy between August 2005 and November 2007. Main outcome measures: Platelet response (measured at least 3‐monthly) following successful H. pylori eradication therapy (confirmed by urea breath test 4 weeks later). Results: Of 16 patients, seven were H. pylori‐ negative and underwent laparoscopic splenectomy. Nine were H. pylori ‐positive and successfully underwent H. pylori eradication therapy; five of the nine had an initial platelet response. Four patients had platelet counts > 100 × 10 9 /L (reference range, 140–450 × 10 9 /L) and were off all immunosuppression at 9 months; three had a sustained response beyond 12 months. One patient had an initial response at 3 months (15 × 10 9 /L to 208 × 10 9 /L), but relapsed 4 months after H. pylori eradication and underwent splenectomy with platelet count recovery. The remaining four patients showed no platelet response and subsequently underwent splenectomy. Conclusion: Larger prospective studies are needed to fully ascertain the role of H. pylori in Australian patients with ITP. However, H . pylori eradication is simple and safe. H. pylori screening and eradication should be considered before immunosuppression or splenectomy.