Skip to main content
Top
Published in: BMC Gastroenterology 1/2023

Open Access 01-12-2023 | Anemia | Research

Eradication therapy may decrease the risk of immune thrombocytopenia after Helicobacter pylori infection: a retrospective cohort study in Taiwan

Authors: Mitsuhiro Koseki, Ming‑Jen Sheu, Kang-Ting Tsai, Chung-Han Ho, Hsiao-Hua Liu, Hung-Jung Lin, Chien-Liang Lin, Chien-Cheng Huang

Published in: BMC Gastroenterology | Issue 1/2023

Login to get access

Abstract

Background

Helicobacter pylori (HP) eradication therapy (HPE) is recommended for patients with unexplained immune thrombocytopenia (ITP); however, the role of HPE in preventing ITP in patients with HP infection remains unclear. Therefore, this study was designed to clarify it.

Methods

This study was conducted at a tertiary medical center and included all adult patients with HP infection between January 1, 2016 and December 31, 2018. We compared the risk of developing ITP between patients with and without HPE. All patients were followed up until December 31, 2020.

Results

After excluding patients with thrombocytopenia, 1995 adult patients with HP infection, including 1188 patients with HPE and 807 patients without HPE, were included in this study. The mean age of the patients with HPE was 57.9 years, whereas that of those without HPE was 61.6 years. The percentage of males was 56% in patients with HPE and 59% in those without HPE. Patients without HPE had a higher risk of ITP than those with HPE after adjusting for age, sex, the Charlson Comorbidity Index, and comorbidities [adjusted odds ratio (OR) 1.76; 95% confidence interval (CI) 1.16–2.68]. Stratified analyses showed that the higher risk was found only in males (adjusted OR: 1.70; 95% CI 1.03–2.80). In addition to HPE, male sex and anemia were independent predictors of ITP in patients with HP infection.

Conclusion

This study showed that adult patients with HP infection not receiving HPE had a higher risk of developing ITP. We suggest that HPE should be considered, particularly in males and those who have anemia, to prevent ITP.
Appendix
Available only for authorised users
Literature
1.
go back to reference Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212–39.CrossRef Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG clinical guideline: treatment of Helicobacter pylori infection. Am J Gastroenterol. 2017;112:212–39.CrossRef
2.
go back to reference Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153:420–9.CrossRef Hooi JKY, Lai WY, Ng WK, et al. Global prevalence of Helicobacter pylori infection: systematic review and meta-analysis. Gastroenterology. 2017;153:420–9.CrossRef
3.
go back to reference Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019;381:945–55.CrossRef Cooper N, Ghanima W. Immune thrombocytopenia. N Engl J Med. 2019;381:945–55.CrossRef
5.
go back to reference Kim H, Lee WS, Lee KH, et al. Efficacy of Helicobacter pylori eradication for the 1st line treatment of immune thrombocytopenia patients with moderate thrombocytopenia. Ann Hematol. 2015;94:739–46.CrossRef Kim H, Lee WS, Lee KH, et al. Efficacy of Helicobacter pylori eradication for the 1st line treatment of immune thrombocytopenia patients with moderate thrombocytopenia. Ann Hematol. 2015;94:739–46.CrossRef
6.
go back to reference Fujimura K, Kuwana M, Kurata Y, et al. Is eradication therapy useful as the first line of treatment in Helicobacter pylori-positive idiopathic thrombocytopenic purpura? Analysis of 207 eradicated chronic ITP cases in Japan. Int J Hematol. 2005;81:162–8.CrossRef Fujimura K, Kuwana M, Kurata Y, et al. Is eradication therapy useful as the first line of treatment in Helicobacter pylori-positive idiopathic thrombocytopenic purpura? Analysis of 207 eradicated chronic ITP cases in Japan. Int J Hematol. 2005;81:162–8.CrossRef
8.
go back to reference Kashiwagi H, Kuwana M, Hato T, et al. Reference guide for management of adult immune thrombocytopenia in Japan: 2019 revision. Int J Hematol. 2020;111:329–51.CrossRef Kashiwagi H, Kuwana M, Hato T, et al. Reference guide for management of adult immune thrombocytopenia in Japan: 2019 revision. Int J Hematol. 2020;111:329–51.CrossRef
9.
go back to reference Jang JH, Kim JY, Mun YC, et al. Management of immune thrombocytopenia: Korean experts recommendation in 2017. Blood Res. 2017;52:254–63.CrossRef Jang JH, Kim JY, Mun YC, et al. Management of immune thrombocytopenia: Korean experts recommendation in 2017. Blood Res. 2017;52:254–63.CrossRef
10.
go back to reference Park YH, Kim DY, Kim S, et al. Management of immune thrombocytopenia: 2022 update of Korean experts recommendations. Blood Res. 2022;57:20–8.CrossRef Park YH, Kim DY, Kim S, et al. Management of immune thrombocytopenia: 2022 update of Korean experts recommendations. Blood Res. 2022;57:20–8.CrossRef
11.
go back to reference Chen YM, Kao Y, Hsu CC, et al. Real-time interactive artificial intelligence of things-based prediction for adverse outcomes in adult patients with pneumonia in the emergency department. Acad Emerg Med. 2021;28:1277–85.CrossRef Chen YM, Kao Y, Hsu CC, et al. Real-time interactive artificial intelligence of things-based prediction for adverse outcomes in adult patients with pneumonia in the emergency department. Acad Emerg Med. 2021;28:1277–85.CrossRef
12.
go back to reference Wang YK, Kuo FC, Liu CJ, et al. Diagnosis of Helicobacter pylori infection: Current options and developments. World J Gastroenterol. 2015;21:11221–35.CrossRef Wang YK, Kuo FC, Liu CJ, et al. Diagnosis of Helicobacter pylori infection: Current options and developments. World J Gastroenterol. 2015;21:11221–35.CrossRef
13.
go back to reference Sheu BS, Wu MS, Chiu CT, et al. Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale. Helicobacter. 2017;22(3):e12368.CrossRef Sheu BS, Wu MS, Chiu CT, et al. Consensus on the clinical management, screening-to-treat, and surveillance of Helicobacter pylori infection to improve gastric cancer control on a nationwide scale. Helicobacter. 2017;22(3):e12368.CrossRef
14.
go back to reference Huang YQ, Gou R, Diao YS, et al. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. J Zhejiang Univ Sci B. 2014;15:58–66.CrossRef Huang YQ, Gou R, Diao YS, et al. Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. J Zhejiang Univ Sci B. 2014;15:58–66.CrossRef
16.
go back to reference Zimmer J, Hentges F, Andres E. Borderline thrombocytopenia or mild idiopathic thrombocytopenic purpura? PLoS Med. 2006;3:e362.CrossRef Zimmer J, Hentges F, Andres E. Borderline thrombocytopenia or mild idiopathic thrombocytopenic purpura? PLoS Med. 2006;3:e362.CrossRef
17.
go back to reference Takahashi T, Yujiri T, Shinohara K, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004;124:91–6.CrossRef Takahashi T, Yujiri T, Shinohara K, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004;124:91–6.CrossRef
18.
go back to reference Bai Y, Wang Z, Bai X, et al. Cross-reaction of antibody against Helicobacter pylori urease B with platelet glycoprotein IIIa and its significance in the pathogenesis of immune thrombocytopenic purpura. Int J Hematol. 2009;89:142–9.CrossRef Bai Y, Wang Z, Bai X, et al. Cross-reaction of antibody against Helicobacter pylori urease B with platelet glycoprotein IIIa and its significance in the pathogenesis of immune thrombocytopenic purpura. Int J Hematol. 2009;89:142–9.CrossRef
19.
go back to reference Takeuchi H, Okamoto A. Helicobacter pylori Infection and chronic immune thrombocytopenia. J Clin Med. 2022;11(16):4822.CrossRef Takeuchi H, Okamoto A. Helicobacter pylori Infection and chronic immune thrombocytopenia. J Clin Med. 2022;11(16):4822.CrossRef
20.
go back to reference Andres E, Mecili M, Fothergill H, Zimmer J, Vogel T, Maloisel F. Gender-related analysis of the clinical presentation, treatment response and outcome in patients with immune thrombocytopenia. Presse Med. 2012;41:e426–31.CrossRef Andres E, Mecili M, Fothergill H, Zimmer J, Vogel T, Maloisel F. Gender-related analysis of the clinical presentation, treatment response and outcome in patients with immune thrombocytopenia. Presse Med. 2012;41:e426–31.CrossRef
21.
go back to reference Andres E. What impact for sex difference on immune thrombocytopenic purpura? Women Health Open J. 2016;2:e1–3.CrossRef Andres E. What impact for sex difference on immune thrombocytopenic purpura? Women Health Open J. 2016;2:e1–3.CrossRef
22.
go back to reference Afsharipour S, Nazari R, Douraghi M. Seroprevalence of anti-Helicobacter pylori and anti-cytotoxin-associated gene A antibodies among healthy individuals in center of Iran. Iran J Basic Med Sci. 2014;17:547–52. Afsharipour S, Nazari R, Douraghi M. Seroprevalence of anti-Helicobacter pylori and anti-cytotoxin-associated gene A antibodies among healthy individuals in center of Iran. Iran J Basic Med Sci. 2014;17:547–52.
23.
go back to reference Ando T, Tsuzuki T, Mizuno T, et al. Characteristics of Helicobacter pylori-induced gastritis and the effect of H. pylori eradication in patients with chronic idiopathic thrombocytopenic purpura. Helicobacter. 2004;9:443–52.CrossRef Ando T, Tsuzuki T, Mizuno T, et al. Characteristics of Helicobacter pylori-induced gastritis and the effect of H. pylori eradication in patients with chronic idiopathic thrombocytopenic purpura. Helicobacter. 2004;9:443–52.CrossRef
24.
go back to reference Chen MJ, Bair MJ, Chen PY, et al. Declining trends of prevalence of Helicobacter pylori infection and incidence of gastric cancer in Taiwan: an updated cross-sectional survey and meta-analysis. Helicobacter. 2022;27(5):e12914.CrossRef Chen MJ, Bair MJ, Chen PY, et al. Declining trends of prevalence of Helicobacter pylori infection and incidence of gastric cancer in Taiwan: an updated cross-sectional survey and meta-analysis. Helicobacter. 2022;27(5):e12914.CrossRef
25.
go back to reference Teawtrakul N, Sawadpanich K, Sirijerachai C, Chansung K, Wanitpongpun C. Clinical characteristics and treatment outcomes in patients with Helicobacter pylori-positive chronic immune thrombocytopenic purpura. Platelets. 2014;25:548–51.CrossRef Teawtrakul N, Sawadpanich K, Sirijerachai C, Chansung K, Wanitpongpun C. Clinical characteristics and treatment outcomes in patients with Helicobacter pylori-positive chronic immune thrombocytopenic purpura. Platelets. 2014;25:548–51.CrossRef
26.
go back to reference Huang Q, Jia X, Chu Y, Zhang X, Ye H. Helicobacter pylori Infection in geriatric patients: current situation and treatment regimens. Front Med (Lausanne). 2021;8: 713908.CrossRef Huang Q, Jia X, Chu Y, Zhang X, Ye H. Helicobacter pylori Infection in geriatric patients: current situation and treatment regimens. Front Med (Lausanne). 2021;8: 713908.CrossRef
Metadata
Title
Eradication therapy may decrease the risk of immune thrombocytopenia after Helicobacter pylori infection: a retrospective cohort study in Taiwan
Authors
Mitsuhiro Koseki
Ming‑Jen Sheu
Kang-Ting Tsai
Chung-Han Ho
Hsiao-Hua Liu
Hung-Jung Lin
Chien-Liang Lin
Chien-Cheng Huang
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Gastroenterology / Issue 1/2023
Electronic ISSN: 1471-230X
DOI
https://doi.org/10.1186/s12876-023-02664-z

Other articles of this Issue 1/2023

BMC Gastroenterology 1/2023 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.