HELICOBACTER PYLORI AND IDIOPATHIC THROMBOCYTOPENIC PURPURA (ITP); IS THERE ANY ASSOCIATION
Main Article Content
Keywords
Idiopathic thrombocytopenic purpura (ITP), Helicobacter pylori (H.pylori), Platelet Count.
Abstract
Background: Idiopathic thrombocytopenic purpura (ITP) is a hematological condition characterized by platelet hypersensitivity, which is often accompanied by autoantibodies and results in platelet destruction. While the actual etiology of ITP is unknown, it has been associated to a number of medical disorders, including infectious infections. Helicobacter pylori (H. pylori) infection has recently appeared as a possible factor to ITP, with research showing that its eradication improves platelet counts.
Objective: To investigate the association between H. pylori infection and ITP.
Study Design: This case-control study.
Duration and Place of the Study: This study conducted at the Department of Gastroenterology, Lady Reading Hospital, Peshawar, from February 2021 to February 2023.
Material and Methods: The study included 37 patients with immune thrombocytopenia throughout a two-year period and compared with healthy controls in the ration 1:2. Male and female patients between the ages of 18 and 60 years with ITP were enrolled. Platelet counts of 150,000 cells per mm3 was used to diagnose ITP after other causes of thrombocytopenia had been excluded. Data collection included demographic information, a medical history, and a focus on gastric symptoms.
Results: Among cases, male patients constituted (51.4%) over (48.6%) females. The control group included 74 non-ITP patients, the majority of them were between the ages of 18-45 (79.77%). The gender distribution was almost equivalent to cases, with 48.64% males and 51.35% females. Only 5 (6.75%) of the 74 healthy controls tested positive for H. pylori, compared to 18 (48.6%) of the 37 ITP patients. 59.46% (n=22) of the 37 ITP patients reported having gastric symptoms, whereas the remaining 40.54% (n=15) did not. The odds ratio was 13.0 with 95% CI 4.2-39.8 indicating significant association between ITP and H.pylori.
Conclusion: This study suggests a significant relationship between H. pylori and ITP. The study also stresses the need of healthcare practitioners addressing gastrointestinal diseases and genetic factors in ITP development. Recognizing these linkages may help healthcare practitioners monitor and manage ITP.
References
2. Kusters JG, Van Vliet AH, Kuipers EJ. Pathogenesis of Helicobacter pylori infection. Clinical microbiology reviews. 2006 Jul;19(3):449-90.
3. Wen H, Luo J, Li J, Li X. Helicobacter pylori infection in rheumatic diseases. Arthritis research & therapy. 2012 Jan 1;14(Suppl 1):P74.
4. Bravo D, Hoare A, Soto C, Valenzuela MA, Quest AF. Helicobacter pylori in human health and disease: Mechanisms for local gastric and systemic effects. World journal of gastroenterology. 2018 Jul 7;24(28):3071.
5. Testerman TL, Morris J. Beyond the stomach: an updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World journal of gastroenterology: WJG. 2014 Sep 9;20(36):12781.
6. Marques AR, Sousa L, Mendes M, Apolinário I. Immune thrombocytopenia associated with Helicobacter pylori - unclear associative mechanisms. Hematol Transfus Cell Ther. 2019 Jul-Sep;41(3):272-274.
7. White JR, Winter JA, Robinson K. Differential inflammatory response to Helicobacter pylori infection: etiology and clinical outcomes. Journal of inflammation research. 2015 Aug 13:137-47.
8. Chmiela M, Gonciarz W. Molecular mimicry in Helicobacter pylori infections. World journal of gastroenterology. 2017 Jun 6;23(22):3964.
9. Swinkels M, Rijkers M, Voorberg J, Vidarsson G, Leebeek FW, Jansen AG. Emerging concepts in immune thrombocytopenia. Frontiers in immunology. 2018 Apr 30;9:880.
10. Chmiela M, Karwowska Z, Gonciarz W, Allushi B, Stączek P. Host pathogen interactions in Helicobacter pylori related gastric cancer. World journal of gastroenterology. 2017 Mar 3;23(9):1521.
11. Hagymási K, Tulassay Z. Helicobacter pylori infection: new pathogenetic and clinical aspects. World journal of gastroenterology: WJG. 2014 Jun 6;20(21):6386.
12. Testerman TL, Morris J. Beyond the stomach: an updated view of Helicobacter pylori pathogenesis, diagnosis, and treatment. World journal of gastroenterology: WJG. 2014 Sep 9;20(36):12781.
13. Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Official journal of the American College of Gastroenterology| ACG. 2017 Feb 1;112(2):212-39.
14. Negrini R, Lisato L, Zanella I, Cavazzini L, Gullini S, Villanacci V, Poiesi C, Albertini A, Ghielmi S. Helicobacter pylori infection induces antibodies cross-reacting with human gastric mucosa. Gastroenterology. 1991 Aug;101(2):437-45.
15. Kuwana M. Helicobacter pylori-associated immune thrombocytopenia: clinical features and pathogenic mechanisms. World Journal of Gastroenterology: WJG. 2014 Jan 1;20(3):714.
16. Psaila B, Bussel JB. Refractory immune thrombocytopenic purpura: current strategies for investigation and management. British journal of haematology. 2008 Oct;143(1):16-26.
17. Al-Outaibi GT. Association between Helicobacter pylori infection and rheumatic heart disease (Doctoral dissertation, KING ABDULAZIZ UNIVERSITY JEDDAH).
18. Stasi R, Rossi Z, Stipa E, Amadori S, Newland AC, Provan D. Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura. The American journal of medicine. 2005 Apr 1;118(4):414-9.
19. Emilia G, Luppi M, Zucchini P, Morselli M, Potenza L, Forghieri F, Volzone F, Jovic G, Leonardi G, Donelli A, Torelli G. Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles. Blood, The Journal of the American Society of Hematology. 2007 Dec 1;110(12):3833-41.
20. Cines DB, Bussel JB, Liebman HA, Luning Prak ET. The ITP syndrome: pathogenic and clinical diversity. Blood, The Journal of the American Society of Hematology. 2009 Jun 25;113(26):6511-21.
21. Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N, Cuker A, Despotovic JM, George JN, Grace RF, Kühne T, Kuter DJ, Lim W, McCrae KR, Pruitt B, Shimanek H, Vesely SK. American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv. 2019 Dec 10;3(23):3829-3866.
22. Barbosa AM, Ribeiro RA, Silva CÍ, Cruz FW, Azevedo O, Pitombeira M. Platelet count response to Helicobacter pylori eradication for idiopathic thrombocytopenic purpura in northeastern Brazil. Rev Bras Hematol Hemoter. 2018;40(1):12–17.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Muhammad Kashif
Department of Gastroenterology, Lady Reading Hospital, Peshawar
Ubaid Ullah Sami
Department of Medicine, Lady Reading Hospital, Peshawar
Muhammad Kamran Hassan
Department of Gastroenterology, Lady Reading Hospital Peshawar
Muhammad Taimur
Department of Medicine, Bacha Khan Medical Complex, Swabi
Muhammad Adeel
Department of Gastroenterology, SIUT, Karachi
Jawad Mahmood
Department of Gastroenterology, Good Hope Hospital, Birmingham, UK
Sapna Faryal
Department of Medicine, Lady Reading Hospital, Peshawar
Farhan Saeed
Khyber Teaching Hospital, Peshawar