Helicobacter pylori Eradication in Idiopathic Thrombocytopenic Purpura: A Meta-Analysis of Randomized Trials.

Bum Jun Kim,Hyeong Su Kim,Jung Han Kim,Hyun Joo Jang

doi:10.1155/2018/6090878

Abstract

Objective Several recent reviews of published studies have shown that the eradication of H. pylori infection in patients with ITP improved thrombocytopenia in about half of the cases. However, most included studies were observational case series. We performed the first meta-analysis of randomized trials to gain a better insight into the effect of H. pylori eradication in ITP patients. Methods A systematic computerized search of the electronic databases including PubMed, EMBASE, Google Scholar, and Cochrane Library (up to December 2017) was conducted. Results From six studies, a total of 241 patients (125 in eradication group and 116 in control group) were included in the meta-analysis. Patients in the eradication group showed significantly higher overall platelet response rate than those in the control group (odds ratio = 1.93, 95% confidence interval: 1.01–3.71, P = 0.05). In the subgroup analysis, however, children in the eradication group failed to show statistically better response rate than those in the noneradication group (odds ratio = 1.80, 95% confidence interval: 0.88–3.65, P = 0.11). Conclusions This meta-analysis indicates that H. pylori eradication has a significant therapeutic effect in patients with ITP. Considering the intrinsic limits in the design and sample size of the included studies, however, large randomized controlled trials are warranted to validate the therapeutic impact of H. pylori eradication in adults as well as children with ITP.

Highlights

Idiopathic or immune thrombocytopenic purpura (ITP) is an autoimmune-mediated acquired bleeding disorder of children as well as adults
Despite the findings indicating that H. pylori infection plays an etiological role in ITP, several randomized trials to date have shown the inconsistent results in the effect of bacterium eradication
In this meta-analysis of 6 randomized trials, we evaluated the therapeutic effect of H. pylori eradication in patients with ITP

Summary

Introduction

Idiopathic or immune thrombocytopenic purpura (ITP) is an autoimmune-mediated acquired bleeding disorder of children as well as adults. It is characterized by the destruction of host platelet caused by anti-platelet antibodies [1]. The mechanisms that trigger the development of platelet auto-antibodies remain poorly understood. Persistent thrombocytopenia for more than 6 or 12 months defines the chronic form of ITP [2, 3]. ITP is typically a diagnosis of exclusion, made by clinicians after ruling out other possible etiologies. ITP can be a primary disease or secondary to a variety of etiologies including bacterial or viral infection, autoimmune disease, or neoplasm [1,2,3]

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Conclusion