Efficacy Of Helicobacter Pylori Eradication In Children With Chronic Idiopathic Thrombocytopenic Purpura

Background and objective:Helicobacter pylori (H pylori)is a ubiquitous bacterium which humans are susceptible to.It is estimated that over half people of the world are infected with the bacterium.The prevalence of H pylori in China is about 59%.Diseases caused by it impose great threats on our health. Since Warren and Marshall reported Helicobacter pylori is a causative agent of gastritis and peptic ulcers,many studies found it is also a high risk factor for the development of gastric cancer and mucosa-associated lymphoid tissue lymphoma(MALT).The bacterium infection has also been implicated in the pathogenesis of extrodigestive disorders, such as cardiovascular diseases, respiratory diseases and autoimmune diseases. Idiopathic thrombocytopenic purpura (ITP) is a common autoimmune hemorrhagic disorder , caused by platelet associated immune globulin (PAIgG) emerged in the serum which leads to platelet destruction and spontaneous bleeding.Part of the patients become chronic ITP because of irrational therapy and recurrence. Adverse effects bring about by immunosuppressive treatments bring great harm to the patients.Reseachers from Italy and Japan investigated the relationship between H pylori infection and chronic ITP in adult in recent 10 years and found significant platelet count increase and PAIgG decrease after eradication of H pylori in chronic ITP patients with H pylori,while those whose H pylori infection were not successfully eradicated, the platelet count and PAIgG changed little.They concluded that H pylori is a causative agent of chronic ITP, eradication of H pylori can increase platelet count in chronic ITP patients.On the other side, some subsequent studies disagreed with the conclusion. The relationship between H pylori and chronic ITP remains controversial. The aim of this study is to explore the correlation between H pylori and children chronic ITP,to elucidate the role of H pylori as a causative agent in chronic ITP in children and to find a nonimmunosuppressive therapy for children with chronic ITP. Methods: From October 2008 to October 2009,we investigated the presence of H pylori in 37children with chronic ITP consecutively admitted to our hospital by H pylori stool test(H pyloriSA),then divided them into two groups: H pylori-positive and H pylori- negative.Irrespective of H pylori infection all the children in the two groups received the H pylori eradication regimen including amoxicillin at a dose of 50mg/kg·d ,clarithronmycin 15mg/kg·d and omeprazole 0.8mg/kg·d for 2 weeks, if anyone was allergic to amoxicillin,then took metronidazole 30mg/kg·d instead. At baseline we measured the platelet count for every child. Four weeks after H pylori eradication, H pylori-positive children received HpSA test again to evaluate the clearance of H pylori.Platele counts were measured every two weeks during 6 months of follow-up. Results: (1) Of the 37 children 22 were tested H pylori positive,the incidence rate of H pylori infection was 59.5%.(2) 17 of 22 H pylori positive children were successfully eradicated.(3) Platelet counts increased in 11 children who were successfully H pylori eradicated after eight to twelve weeks.The average platelet count of H pylori-positive children was higher than that of H pylori-negative children(P=0.006). Conclusions:Eradication of H pylori can increase the platelet count in chronic ITP children with H pylori, H pylori may play a role in the pathogenesis of chronic ITP. It is recommended to have routine H pylori infection test and eradicate H pylori infection to liberate the patients from immunosuppressive treatment.