The relationship between immune thrombocytopenic purpura and Helicobacter pylori infection in children: where is the truth?

Abstract

Helicobacter pylori infection has been associated in recent years with a number of autoimmune diseases and, in particular, with immune thrombocytopenic purpura (ITP) [1]. This communication is intended as our contribution to the lively debate on the 'state of the art' of these disorders in paediatric patients. The low incidence of H. pylori infection in the paediatric population makes it difficult to gather together enough patients to comprehensively study a possible relationship between H. pylori infection and other diseases. However, a study by Miele et al. in 2004 [4] reported that the seroprevalence rate of H. pylori in southern Italian children was 23% when gastrointestinal symptoms were present and 18.9% when they were absent. Between January and December 2005, we prospectively investigated the prevalence of H. pylori infection and the effect of bacterium eradication on platelet count recovery in children affected by chronic ITP. Our study included 39 children (26 girls and 13 boys) with a median age of 136 months (range: 53–205 months). The eligibility criteria were: (1) thrombocytopenia (platelets <100,000/mmc) lasting more than 6 months; (2) normal or increased megakaryocytes in the bone marrow; (3) no treatment with intravenous immunoglobulins and/or steroids for at least 1 month prior to the study. An H. pylori infection was diagnosed if at least two of the following tests were positive: (1) the 13C urea breath test (UBT); (2) the detection of specific serum IgG antibodies; (3) the H. pylori stool antigen test. Only infected children were given the conventional treatment of amoxicillin at 50 mg/kg per day and clarithromycin at 10 mg/kg per day for 14 days, and omeprazole at 1 mg/kg per day for 4 weeks. Eradication was assessed at 6 weeks following the end of the treatment by the UBT; if the infection was still present, the children were treated once again. Eight patients tested positive (two tests) for H. pylori infection and were provided treatment. Five patients required one course of treatment for successful eradication and two patients required two courses of treatment. One patient needed a third course and was still infected at the end of the study period. The platelet counts did not show any trend towards improvement in the infected children following the eradication treatment and were identical to those of the uninfected patients (for infected patients: median basal platelet count was 33× Eur J Pediatr (2007) 166:1067–1068 DOI 10.1007/s00431-006-0344-4