International Journal of Hematology

, Volume 84, Issue 4, pp 309–315 | Cite as

Helicobacter pylori and Immune Thrombocytopenic Purpura: Unsolved Questions and Controversies

Article

Abstract

Immune thrombocytopenic purpura (ITP) is an autoimmune disease mediated by anti-platelet autoantibodies. Recent accumulating evidence indicates that eradication of Helicobacter pylori (H pylori) is effective in increasing platelet count in nearly half of ITP patients infected with this bacterium. The H pylori eradication therapy for adult ITP is becoming very popular in Japan and is now chosen as an initial treatment in H pylori-infected patients. The lack of efficacy of the H pylori eradication regimen in H pylori-negative ITP patients clearly indicates that platelet recovery results from the disappearance of H pylori itself. Despite extensive efforts, clinical features characteristic to H pylori-related ITP and factors predicting the response after the H pylori eradication therapy have not been identified. Great variability in the efficacy of the H pylori eradication therapy in ITP patients exists among countries: a higher response rate has been found in Japan and Italy than in the United States and non-Italian European countries. Some children infected with H pylori show the platelet response after successful eradication of H pylori, but the H pylori eradication therapy is ineffective in patients with secondary ITP. The pathogenesis of ITP associated with H pylori remains obscure; the mechanisms are not simple and may involve multiple steps, including cross-reactivity between H pylori antigen and platelets, and suppression of the reticuloendothelial system. Further studies to evaluate the mechanisms responsible for the platelet response in ITP patients after successful eradication of H pylori may be useful in clarifying the pathogenesis of ITP and developing new therapeutic strategies for ITP.

Key words

Immune thrombocytopenic purpura Helicobacter pylori Autoantibody Molecular mimicry 

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Copyright information

© The Japanese Society of Hematology 2006

Authors and Affiliations

  1. 1.Division of Rheumatology, Department of Internal MedicineKeio University School of MedicineTokyoJapan
  2. 2.Division of Hematology, Department of Internal MedicineKeio University School of MedicineTokyoJapan

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