Helicobacter pylori infection & immune thrombocytopenic purpura in children and adolescents: A randomized controlled trial. (June 2015)

• Record Type: Journal Article
• Authors: Brito, Helena Shino Hanai; Braga, Josefina Aparecida Pellegrini; Loggetto, Sandra Regina; Machado, Rodrigo Strehl; Granato, Celso Francisco Hernandes; Kawakami, Elisabete
• Is Part Of: Platelets. Volume 26:Number 4(2015:Jun.)
• Page Start: 336
• Page End: 341
• Publication Date: 2015-06
• Subjects: Blood platelets -- Periodicals; Blood Platelets -- Periodicals; 615.39
• DOI: 10.3109/09537104.2014.911836
• Languages: English
• ISSNs: 0953-7104

Abstract

<abstract> <title>Abstract</title> <p> <italic>Helicobacter pylori</italic> and immune thrombocytopenic purpura (ITP) association is not well established in chronic ITP (cITP) in children, although the cure of thrombocytopenia in approximately half of <italic>H. pylori</italic> eradicated adult patients has been described. The aim of this study was to investigate the effect of <italic>H. pylori</italic> eradication on platelet (PLT) recovery in cITP children and adolescents through a randomized, controlled trial. A total of 85 children (mean age 11.4 years) with cITP were prospectively enrolled. Diagnosis of <italic>H. pylori</italic> was established by two locally validated tests, <sup>13</sup>C-urea breath test and monoclonal stool antigen test. Twenty-two infected patients were identified, and randomly allocated into two groups: <italic>H. pylori</italic> treatment group (<italic>n</italic> = 11) and the non-intervention control group (<italic>n</italic> = 11). The control group was offered treatment if the thrombocytopenia persisted after the follow-up. At baseline, there were no differences regarding age, sex, duration of disease, and PLT count between groups. Sixty three of 85 patients were uninfected. PLT response was classified as complete response: PLT > 150 × 10<sup>9 </sup>l<sup>−1</sup>; partial response: PLT 50–150 × 10<sup>9 </sup>l<sup>−1</sup>, or an increase of 20–30 × 10<sup>9 </sup>l<sup>−1</sup>; no response: PLT < 50 × 10<sup>9 </sup>l<sup>−1</sup> or an increase of <20 × 10<sup>9 </sup>l<sup>−1</sup> after at least 6 months of follow-up. Complete response was observed in 60.0% (6/10, one excluded) <italic>H. pylori</italic> eradicated patients vs. 18.2% (2/11) in non-eradicated patients (<italic>p</italic> = 0.08; OR = 6.75) after 6–9 months of follow-up. Among uninfected patients, only 13.8% (8/58) presented complete response. Two non-treated controls were treated after 6–12 months of follow-up, and PLT response was observed in 61.5% (8/13) of <italic>H. pylori</italic> eradicated patients, and in 19.0% (11/58) of uninfected patients (<italic>p</italic> = 0.004). Cytotoxin associated gene A and vacuolating cytotoxin gene A IgG antibodies were present in almost all infected patients. Therefore, the study suggests that <italic>H. pylori</italic> eradication plays a role in the management of <italic>H. pylori</italic> infected cITP children and adolescents.</p> </abstract>