Can Eradication Therapy for Helicobacter pylori Really Improve the Thrombocytopenia in Idiopathic Thrombocytopenic Purpura? Our Experience and a Literature Review


Helicobacter pylori has recently been postulated to play a role in the pathogenesis of autoimmune diseases, including idiopathic thrombocytopenic purpura (ITP). We investigated the prevalence ofH pylori infection and the effects of its eradication in 61 patients with ITP.H pylori infection was found in 50 patients (83%), an incidence significantly higher than not only healthy volunteers in Japan (60%) but also subjects in other reported ITP series (approximately 43%–71%). In our study, the mean age ofH pylori-positive ITP patients (58.0 years) was significantly higher than that ofH pylori-negative ITP patients (40.5 years). Bacterium eradication efforts were performed in 29 infected ITP patients and succeeded in 27 patients (93%). The 29 patients with eradicatedH pylori infections showed significant increases in platelet counts compared with patients with uneradicated infections or who wereH pylori-negative. During the follow-up period (median, 11.0 months), 16 (55%) of 29 patients achieved a major or a minor response. The patients who achieved a major response had not received previous prednisolone therapy, suggesting a relationship between prednisolone therapy and the response to eradication efforts.The assessment ofH pylori infection and its eradication should be attempted in cases of ITP, because this approach may be a good new strategy for treating some ITP patients, especially elderly Japanese patients. Some regional factors have been suggested as causes ofH pylori-associated ITP.

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


  1. 1.

    Graham DY, Lew GM, Klein PD, et al. Effect of treatment ofHelicobacter pylori infection on the long-term recurrence of gastric or duodenal ulcer: a randomized, controlled study.Ann Intern Med. 1992;116:705–708.

    Article  PubMed  CAS  Google Scholar 

  2. 2.

    Forman D, Newell DG, Fullerton F, et al. Association between infection withHelicobacter pylori and risk of gastric cancer: evidence from a prospective investigation.BMJ. 1991;302:1302–1305.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  3. 3.

    Zentilin P, Savarino V, Garnero A, Accardo S, Seriolo B. IsHelicobacter pylori infection a risk factor for disease severity in rheumatoid arthritis?Gastroenterology. 1999;116:503–504.

    Article  PubMed  CAS  Google Scholar 

  4. 4.

    De Luis DA, Varela C, de la Calle H, et al.Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis.J Clin Gastroenterol. 1998;26:259–263.

    Article  PubMed  Google Scholar 

  5. 5.

    Gasbarrini A, Franceschi F. Autoimmune diseases andHelicobacter pylori infection.Biomed Pharmacother. 1999;53:223–226.

    Article  PubMed  CAS  Google Scholar 

  6. 6.

    Gasbarrini A, Franceschi F, Tartaglione R, Landolfi R, Pola P, Gasbarrini G. Regression of autoimmune thrombocytopenia after eradication ofHelicobacter pylori.Lancet. 1998;352:878.

    Article  PubMed  CAS  Google Scholar 

  7. 7.

    Negrini R, Savio A, Poiesi C, et al. Antigen mimicry betweenHelicobacter pylori and gastric mucosa in the pathogenesis of body atrophic gastritis.Gastroenterology. 1996;111:655–665.

    Article  PubMed  CAS  Google Scholar 

  8. 8.

    McCrae KM, Bussel JB, Mannucci PI, Remuzzi G, Cines DB. Platelets: an update on diagnosis and management of thrombocytopenic disorders.Hematology (Am Soc Hematol Educ Prog). 2001:282–305.

    Article  Google Scholar 

  9. 9.

    Francois B, Trimoreau F, Vignon P, Fixe P, Praloran V, Gastinne H. Thrombocytopenia in the sepsis syndrome: role of hemophagocytosis and macrophage colony-stimulating factor.Am J Med. 1997; 103:114–120.

    Article  PubMed  CAS  Google Scholar 

  10. 10.

    Nagamine T, Ohtuka T, Takehara K, Takagi H, Mori M. Thrombocytopenia associated with hepatitis C viral infection.J Hepatol. 1996;24:135–140.

    Article  PubMed  CAS  Google Scholar 

  11. 11.

    Hohmann AW, Booth K, Peter V, Gordon DL, Comacchio RM. Common epitope on HIV p24 and human platelets.Lancet. 1993; 342:1274–1275.

    Article  PubMed  CAS  Google Scholar 

  12. 12.

    Grimaz S, Damiani D, Brosolo P, Skert C, Geromin A, de Pretis G. Resolution of thrombocytopenia after treatment forHelicobacter pylori: a case report.Haematologica. 1999;84:283–284.

    PubMed  CAS  Google Scholar 

  13. 13.

    Emilia G, Longo G, Luppi M, et al.Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura.Blood. 2001;97:812–814.

    Article  PubMed  CAS  Google Scholar 

  14. 14.

    Kohda K, Kuga T, Kogawa K, et al. Effect ofHelicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura.Br J Haematol. 2002;118:584–588.

    Article  PubMed  Google Scholar 

  15. 15.

    Jarque I, Andreu R, Llopis I, et al. Absence of platelet response after eradication ofHelicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura.Br J Haematol. 2001;115:1002–1003.

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Asaka M, Kimura T, Kudo M, et al. Relationship ofHelicobacter pylori to serum pepsinogens in an asymptomatic Japanese population.Gastroenterology. 1992;102:760–766.

    Article  PubMed  CAS  Google Scholar 

  17. 17.

    Fukuda Y, Tomita Y, Sakagami T, Shimoyama T. Epidemiology ofH pylori infection [in Japanese].Nippon Rinsho. 2002;60(suppl 2):40–48.

    PubMed  Google Scholar 

  18. 18.

    McMillan R. Therapy for adults refractory chronic immune thrombocytopenic purpura.Ann Int Med. 1997;126:307–314.

    Article  PubMed  CAS  Google Scholar 

  19. 19.

    Kawai T, Kawakami K, Kudo S, et al. A new serum antibody test kit for evaluation ofHelicobacter pylori eradication.Int Med. 2002;41:780–783.

    Article  CAS  Google Scholar 

  20. 20.

    Cheson BD, Bennett JM, Kantarjian H, et al. Report of an international working group to standardize response criteria for myelodysplastic syndromes.Blood. 2000;96:3671–3674.

    PubMed  CAS  Google Scholar 

  21. 21.

    Cabtree JE, Lindley IJ. Mucosal interleukin-8 andHelicobacter pylori-associated gastroduodenal disease.Eur J Gastroenterol Hepatol. 1994;6(suppl l):S33-S38.

    Google Scholar 

  22. 22.

    Shimoyama T, Crabtree JE. Bacterial factors and immune pathogenesis inHelicobacter pylori infection.Gut. 1998;43(suppl 1):S2-S5.

    PubMed  PubMed Central  Google Scholar 

  23. 24.

    Akiyama H, Onozawa Y. Effect of omeprazole in chronic idiopathic thrombocytopenic purpura.Am J Hematol. 1998;57:91–92.

    Article  PubMed  CAS  Google Scholar 

  24. 25.

    Luzza F, Imeneo M, Maletta M, et al. Suggestion against an oral-oral rout of transmission forHelicobacter pylori infection: a seroepidemiological study in a rural area.Dig Dis Sci. 1998;43:1488–1492.

    Article  PubMed  CAS  Google Scholar 

  25. 26.

    Tovey FI, Hobsley M. IsHelicobacter pylori the primary cause of duodenal ulceration?J Gastroenterol Hepatol. 1999;14:1053–1056.

    Article  PubMed  CAS  Google Scholar 

  26. 27.

    George JN. Initial management of adults with idiopathic (immune) thrombocytopenic purpura.Blood Rev. 2002;16:37–38.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information



Corresponding authors

Correspondence to Keiko Ando or Takashi Shimamoto or Tetsuzo Tauchi or Yoshikazu Ito or Yuzuru Kuriyama or Akihiko Gotoh or Keisuke Miyazawa or Yukihiko Kimura or Takashi Kawai or Kazuma Ohyashikia.

About this article

Cite this article

Ando, K., Shimamoto, T., Tauchi, T. 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 77, 239–244 (2003).

Download citation

Key words

  • Idiopathic thrombocytopenic purpura
  • Helicobacter pylori
  • Eradication therapy