Idiopathic thrombocytopenia and Helicobacter pylori infection: platelet count increase and early eradication therapy

Dear Sir, Steroid therapy is the first-line treatment for autoimmune thrombocytopenias requiring immunosuppressive therapy. Splenectomy, thrombopoietin receptor agonists and rituximab are considered treatments for relapsed thrombocytopenias. However, for some years it has been proposed that Helicobacter pylori (H. pylori) eradication therapy could be used to treat infected patients with chronic idiopathic thrombocytopenia (ITP). Indeed, in 1998 some Japanese authors reported the case of an elderly patient with chronic ITP who was treated with a proton pump inhibitor because of a concomitant peptic ulcer and who had a significant increase in platelet count1. Subsequently, Gasbarrini et al.2 reported significant increases in platelet counts in eight of eleven patients with ITP in whom H. pylori infection was successfully eradicated: this increase was accompanied, in six of the eight patients, by the disappearance of antiplatelet antibodies. Since then, H. pylori eradication has been variably associated with substantial and persistent improvements of platelet count in patients with ITP. The percentages of partial and complete responses reported in various studies and meta-analyses are around 50% in Japanese and Italian populations and lower in trials in France, Spain and North America3 (...).