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Helicobacter pylori eradication: a novel therapeutic option in chronic immune thrombocytopenic purpura

Vanaja Sivapathasingam, Michael P Harvey and Robert B Wilson
Med J Aust 2008; 189 (7): 367-370.

Summary

Objective: To determine whether Helicobacter pylori eradication is an effective treatment for Australian patients with chronic immune thrombocytopenic purpura (ITP).

Design, setting and patients: Retrospective analysis of clinical records of a consecutive series of ITP patients referred to a gastrointestinal surgeon in a tertiary referral hospital for laparoscopic splenectomy between August 2005 and November 2007.

Main outcome measures: Platelet response (measured at least 3-monthly) following successful H. pylori eradication therapy (confirmed by urea breath test 4 weeks later).

Results: Of 16 patients, seven were H. pylori-negative and underwent laparoscopic splenectomy. Nine were H. pylori-positive and successfully underwent H. pylori eradication therapy; five of the nine had an initial platelet response. Four patients had platelet counts > 100 × 109/L (reference range, 140–450 × 109/L) and were off all immunosuppression at 9 months; three had a sustained response beyond 12 months. One patient had an initial response at 3 months (15 × 109/L to 208 × 109/L), but relapsed 4 months after H. pylori eradication and underwent splenectomy with platelet count recovery. The remaining four patients showed no platelet response and subsequently underwent splenectomy.

Conclusion: Larger prospective studies are needed to fully ascertain the role of H. pylori in Australian patients with ITP. However, H. pylori eradication is simple and safe. H. pylori screening and eradication should be considered before immunosuppression or splenectomy.

  • Vanaja Sivapathasingam1,2
  • Michael P Harvey1
  • Robert B Wilson1

  • 1 Liverpool Hospital, Sydney, NSW.
  • 2 Monash Medical Centre, Melbourne, VIC.

Correspondence: Rbwilson52@hotmail.com

Competing interests:

None identified.

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