World Journal of Pediatrics

, Volume 8, Issue 4, pp 301–308 | Cite as

Is Helicobacter pylori infection associated with Henoch-Schonlein purpura in Chinese children? a meta-analysis

  • Li-Jing Xiong
  • Yu Tong
  • Zhi-Ling Wang
  • Meng MaoEmail author



The prevalence of Helicobacter pylori (H. pylori) infection is high in China. It not only causes the damage of gastric epithelium, but also plays a potential pathogenic role in several extraintestinal diseases. Henoch-Schonlein purpura (HSP) is one of the most common vasculitis syndromes affecting children. Although its cause is unclear, HSP is often considered to be associated with infectious agents. This metaanalysis of previously published studies was conducted using a predefined protocol to evaluate the underlying association between H. pylori infection and HSP in Chinese children.


Predefined search strategy and inclusion criteria were set up to select studies reporting the prevalence of H. pylori infection among HSP children and control groups. Included studies were subjected to quality assessment and data extraction by two independent reviewers. The pooled odds ratio (OR) was calculated as the effect size via both traditional and cumulative meta-analysis. Heterogeneity was investigated by subgroup analysis, and the nonparametric “trim and fill” method was performed to adjust the overall estimate for the existence of publication bias.


Ten eligible studies covering 749 HSP children and 560 controls were included for metaanalysis. Observational epidemiology studies clearly aimed at detecting the potential association between H. pylori infection and HSP with retrospective data collection from the children enrolled consecutively. Overall, 49.27% (369/749) of HSP children had evidence of H. pylori infection compared with 23.39% (131/560) of children in the control group. The pooled OR of H. pylori infection in HSP children (10 studies with 749 HSP children) was 3.80 [95% confidence interval (CI): 2.54–5.68, P<0.001], and the overall estimate from the cumulative meta-analysis confirmed the association with more narrow confidence interval (OR=3.35, 95% CI: 2.95–3.81). In HSP children mainly with abdominal manifestations (8 studies with 337 HSP children), the pooled OR was 4.62 (95% CI: 2.66–8.01, P<0.001). The adjusted pooled OR was 2.04 (95% CI: 1.48–2.82, P<0.001), determined by the nonparametric “trim-andfill” method for eliminating the effect of publication bias. H. pylori eradication therapy (4 studies with 266 HSP children) was capable of reducing the recurrence of HSP (RR=0.38, 95% CI: 0.25–0.58, P<0.001). Although the subgroup analysis for heterogeneity suggested that diagnostic methods and geographical diversity might be account for the heterogeneity, statistical analysis of differences revealed no differences between subgroups, indicating their limited impact on the overall estimates.


These results suggest the necessity of screening H. pylori infection in HSP children, particularly in those with gastrointestinal manifestations in China. Eradication therapy may reduce the recurrence of HSP in children with H. pylori infection. However, further mechanistic and more clinical studies in different populations and regions are needed to confirm this association and the effect of eradication of H. pylori in HSP children.

Key words

Helicobacter pylori Henoch-Schonlein purpura meta-analysis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007;56:772–781.PubMedCrossRefGoogle Scholar
  2. 2.
    Gasbarrini A, Franceschi F, Armuzzi A, Ojetti V, Candelli M, Torre ES, et al. Extradigestive manifestations of Helicobacter pylori gastric infection. Gut 1999;45Suppl 1:I9–I12.PubMedCrossRefGoogle Scholar
  3. 3.
    Leontiadis GI, Sharma VK, Howden CW. Non-gastrointestinal tract associations of Helicobacter pylori infection. Arch Intern Med 1999;159:925–940.PubMedCrossRefGoogle Scholar
  4. 4.
    Saulsbury FT. Henoch-Schonlein purpura in children: report of 100 patients and review of the literature. Medicine 1999;78:395–409.PubMedCrossRefGoogle Scholar
  5. 5.
    Trapani S, Micheli A, Grisolia F, Resti M, Chiappini E, Falcini F, et al. Henoch Schonlein purpura in childhood: epidemiological and clinical analysis of 150 cases over a 5-year period and review of literature. Semin Arthritis Rheum 2005;35:143–153.PubMedCrossRefGoogle Scholar
  6. 6.
    Reinauer S, Megahed M, Goerz G, Ruzicka T, Borchard F, Susanto F, et al. Schönlein-Henoch purpura associated with gastric Helicobacter pylori infection. J Am Acad Dermatol 1995;33:876–879.PubMedCrossRefGoogle Scholar
  7. 7.
    Cecchi R, Torelli E. Schonlein-Henoch purpura in association with duodenal ulcer and gastric Helicobacter pylori infection. J Dermatol 1998;25:482–484.PubMedGoogle Scholar
  8. 8.
    Machet L, Vaillant L, Machet MC, Buchier M, Lorette G. Schönlein-Henoch purpura associated with gastric Helicobacter pylori infection. Dermatology 1997;194:86.PubMedCrossRefGoogle Scholar
  9. 9.
    Kellerman P. Henoch-Schönlein purpura in adults. Am J Kidney Dis 2006;48:1009–1016.PubMedCrossRefGoogle Scholar
  10. 10.
    Mozrzymas R, d’Amore ES, Montini G, Guariso G. Schönlein-Henoch vasculitis and chronic Helicobacter pylori associated gastritis and duodenal ulcer: a case report. Pediatr Med Chir 1997;19:468.Google Scholar
  11. 11.
    Mytinger JR, Patterson JW, Thibault ES, Webb J, Saulsbury FT. Henoch-Schonlein Purpura associated with Helicobacter pylori Infection in a Child. Pediatr Dermatol 2008;25:630–632.PubMedCrossRefGoogle Scholar
  12. 12.
    Barratt J, Bailey EM, Buck KS, Mailley J, Moayyedi P, Feehally J, et al. Exaggerated systemic antibody response to mucosal Helicobacter pylori infection in IgA nephropathy. Am J Kidney Dis 1999;33:1049–1057.PubMedCrossRefGoogle Scholar
  13. 13.
    Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med 2002;347:1175–1186.PubMedCrossRefGoogle Scholar
  14. 14.
    Hunt RH, Xiao SD, Megraud F, Leon-Barua R, Bazzoli F, van der Merwe S, et al. Practice Guideline highlights: Helicobacter pylori in developing countries. WGO-OMGE 2006;11:22–29.Google Scholar
  15. 15.
    Covacci A, Telford JL, Del Giudice G, Parsonnet J, Rappuoli R. Helicobacter pylori virulence and genetic geography. Science 1999;284:1328–1333.PubMedCrossRefGoogle Scholar
  16. 16.
    van der Ende A, Pan ZJ, Bart A, van der Hulst RW, Feller M, Xiao SD, et al. cag-A-positive Helicobacter pylori populations in China and The Netherlands are distinct. Infect Immun 1998;66:1822–1826.PubMedGoogle Scholar
  17. 17.
    Kersulyte D, Mukhopadhyay AK, Velapatiňo B, Su W, Pan Z, Garcia C, et al. Differences in genotypes of Helicobacter pylori from different human populations. J Bacteriol 2000;182:3210–3218.PubMedCrossRefGoogle Scholar
  18. 18.
    Li YY, Hu PJ, Du GG, Hazell SL. The prevalence of Helicobacter pylori infection in the Peoples Republic of China. Am J Gastroenterol 1999;86:446–449.Google Scholar
  19. 19.
    Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000;283:2008–2012.PubMedCrossRefGoogle Scholar
  20. 20.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 2003;73:712–716.PubMedCrossRefGoogle Scholar
  21. 21.
    The Cochrane Collaboration. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.0 [updated February 2008] The Cochrane Collaboration, 2008.Google Scholar
  22. 22.
    Higgins JP, Thompson SG. Quantifying heterogeneity in a metaanalysis. Stat Med 2002;21:1539–1558.PubMedCrossRefGoogle Scholar
  23. 23.
    Wang YL, Xue YZ. Explore the relationship between Helicobacter pylori infection and Henoch-Schonlein purpura. Sichuan Med J 2004;25:176–177.Google Scholar
  24. 24.
    Zhang WY, Tong LZ, Zhan JF. Relation study between Henoch-Scholein purpura and Helicobacter pylori. Int Med Health Guidance News 2004;10:21–23.Google Scholar
  25. 25.
    Lv X, Chen JG, Wang ZP. Explore the association between Helicobacter pylori infection and Henoch-Schonlein purpura in children. Zhejiang Clin Med J 2005;7:607.Google Scholar
  26. 26.
    Li H, Ding FY, Liu L, Xu Q. Relationship between Helicobacter pylori infection and Henoch-Schonlein purpura in children. J App Clin Pediatr 2006;21:1398–1399.Google Scholar
  27. 27.
    Wang BH, Zhou LQ, Zuo YH. Relationship between Helicobacter pylori infection and Henoch-Schonlein purpura with gastrointestinal involvement in children. Chin J Contemp Pediatr 2007;9:367–369.Google Scholar
  28. 28.
    Yuan JM, Chen HY. Explore the relationship between recurrent Henoch-Schonlein purpura and Helicobacter pylori infection. J Med Forum 2007;28:67–68.Google Scholar
  29. 29.
    Li YH, Zhu L, Shao XS, Jang XH. Explore the correlation of Helicobacter pylori infection and Henoch-Schonlein purpura. Act Acad Med ZunYi 2008;31:398–400.Google Scholar
  30. 30.
    Li J, Liu HL, Ye Q. Study of relationship between Helicobacter pylori infection and Henoch-Schonlein purpura in children. J Med Theor Prac 2008;21:266–267.Google Scholar
  31. 31.
    Xia XM, Li XC, Kong SY. Research on the relationship between infection of pyloric helicobacterium and Henoch’s allergic purpura among children. Shanghai Med J 2008;29:267–269.Google Scholar
  32. 32.
    Gao XL, Huang YK, Liu M, Li Q, Zeng J, Li HL. Henoch-Schonlein purpura and different patterns of Helicobacter pylori infection in children. World J Gastroenterol 2009;17:198–201.Google Scholar
  33. 33.
    Suzuki T, Matsushima M, Masui A, Watanabe K, Takagi A, Ogawa Y, et al. Effect of Helicobacter pylori eradication in patients with chronic idiopathic thrombocytopenic purpur—a randomized controlled trial. Am J Gastroenterol 2005;100:1265–1270.PubMedCrossRefGoogle Scholar
  34. 34.
    Gisbert JP, Pajares M. Review article: C-urea breath test in the diagnosis of Helicobacter pylori infection-a critical review. Aliment Pharmacol Ther 2004;20:1001–1017.PubMedCrossRefGoogle Scholar
  35. 35.
    Gasbarrini A, Franceschi F. Autoimmune diseases and Helicobacter pylori infection. Biomed Pharmacother 1999;53:223–226.PubMedCrossRefGoogle Scholar
  36. 36.
    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 Helicobacter pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol 2004;124:91–96.PubMedCrossRefGoogle Scholar
  37. 37.
    Yamaguchi H, Osaki T, Kai M, Taguchi H, Kamiya S. Immune response against a cross-reactive epitope on the heat shock protein 60 homologue of Helicobacter pylori. Infect Immun 2000;68:3448–3454.PubMedCrossRefGoogle Scholar
  38. 38.
    Negrini R, Savio A, Poiesi C, Appelmelk BJ, Buffoli F, Paterlini A, et al. Antigenic mimicry between Helicobacter pylori and gastric mucosa in the pathogenesis of body atrophicgastritis. Gastroenterology 1996;111:655–665.PubMedCrossRefGoogle Scholar
  39. 39.
    Shin JI, Koh H, Lee JS. Henoch-Schönlein purpura associated with Helicobacter pylori infection: the pathogenic roles of IgA, C3, and cryoglobulins? Pediatr Dermatol 2009;26:768–769.PubMedCrossRefGoogle Scholar

Copyright information

© Children's Hospital, Zhejiang University School of Medicine and Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Li-Jing Xiong
    • 1
    • 2
    • 3
  • Yu Tong
    • 1
    • 2
    • 3
  • Zhi-Ling Wang
    • 1
  • Meng Mao
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.Department of PediatricsWest China Second University Hospital, Sichuan UniversityChengduChina
  2. 2.Laboratory of Early Developmental and Injuries, West China Institute of Woman and Children’s HealthWest China Second University Hospital, Sichuan UniversityChengduChina
  3. 3.Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of EducationChengduChina
  4. 4.Department of PediatricsWest China Second University Hospital, Sichuan UniversityChengduChina

Personalised recommendations