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Blood, 1 December 2007, Vol. 110, No. 12, pp. 3833-3841.
Prepublished online as a Blood First Edition Paper on July 24, 2007; DOI 10.1182/blood-2006-12-063222.
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CLINICAL TRIALS AND OBSERVATIONS
Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profiles
Giovanni Emilia1,
Mario Luppi1,
Patrizia Zucchini1,
Monica Morselli1,
Leonardo Potenza1,
Fabio Forghieri1,
Francesco Volzone1,
Gordana Jovic1,
Giovanna Leonardi1,
Amedea Donelli1, and
Giuseppe Torelli1
1 Department of Oncology and Hematology, Section of Hematology, University of Modena and Reggio Emilia, Modena, Italy
Eradication of Helicobacter pylori may lead to improvement of chronic immune thrombocytopenic purpura (ITP), although its efficacy over time is uncertain. We report the results of H pylori screening and eradication in 75 consecutive adult patients with ITP. We also used molecular methods to investigate lymphocyte clonality and H pylori genotypes in the gastric biopsies from 10 H pylori–positive patients with ITP and 19 H pylori–positive patients without ITP with chronic gastritis. Active H pylori infection was documented in 38 (51%) patients and successfully eradicated in 34 (89%) patients. After a median follow-up of 60 months, a persistent platelet response in 23 (68%) of patients with eradicated infection was observed; 1 relapse occurred. No differences in mucosal B- or T-cell clonalities were observed between patients with ITP and control participants. Of note, the frequency of the H pylori cagA gene (P = .02) and the frequency of concomitant H pylori cagA, vacAs1, and iceA genes (triple-positive strains; P = .015) resulted statistically higher in patients with ITP than in control participants. All asymptomatic H pylori–positive patients with ITP were suffering from chronic gastritis. Our data suggest a sustained platelet recovery in a proportion of patients with ITP by H pylori eradication alone. Overrepresentation of specific H pylori genotypes in ITP suggests a possible role for bacterium-related factors in the disease pathogenesis.
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