From the Guidelines
Helicobacter pylori infection is associated with immune thrombocytopenia (ITP), a secondary form of thrombocytopenia characterized by low platelet counts due to an autoimmune response triggered by the bacteria. The bacteria trigger an immune response that leads to the production of antibodies that cross-react with platelet antigens, resulting in increased platelet destruction and reduced platelet counts. According to the American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia 1, eradication therapy should be administered in patients who are found to have H pylori infection. Key points to consider in the management of H pylori-associated thrombocytopenia include:
- Eradication of H pylori using standard triple therapy, which typically includes a proton pump inhibitor, amoxicillin, and clarithromycin for 10-14 days.
- Successful eradication of H pylori can lead to resolution of thrombocytopenia in approximately 50-70% of affected patients, usually within 1-3 months after treatment 1.
- The platelet response to H pylori eradication is more common in patients with mild thrombocytopenia and those from areas with high H pylori prevalence.
- Testing for H pylori is recommended in all newly diagnosed ITP patients, especially in regions with high prevalence of this infection.
From the Research
H pylori and Thrombocytopenia
- H pylori infection is associated with immune thrombocytopenia (ITP), a condition characterized by low platelet count due to immune system dysfunction 2, 3, 4, 5.
- The eradication of H pylori infection has been shown to improve platelet counts in patients with ITP, with response rates varying from 27 to 69.2% 2.
- The pathogenesis of H pylori-associated ITP is still uncertain, but it is thought to involve multiple factors, including the modulation of Fcγ-receptor balance and molecular mimicry between H pylori components and platelet antigens 3, 4.
Type of Thrombocytopenia
- H pylori is associated with immune thrombocytopenia (ITP), which is an acquired autoimmune disorder characterized by antiplatelet antibodies and/or CD8+ T cells, resulting in the destruction of platelets and decreased platelet counts 2, 3, 4, 5.
- The thrombocytopenia associated with H pylori infection is typically chronic immune thrombocytopenia (cITP) 3, 5.
Treatment and Response
- Eradication of H pylori infection using triple therapy (amoxicillin, clarithromycin, and a proton-pump inhibitor) has been shown to be effective in improving platelet counts in patients with ITP 2, 6.
- The response to H pylori eradication therapy varies widely among countries, with a higher response rate in Japan compared to the United States and European countries other than Italy 4.