Helicobacter pylori infection & immune thrombocytopenic purpura in children and adolescents: A randomized controlled trial

Helicobacter pylori infection & immune thrombocytopenic purpura in children and adolescents: A randomized controlled trial

Author Hanai Brito, Helena Shino Autor UNIFESP Google Scholar
Pellegrini Braga, Josefina Aparecida Autor UNIFESP Google Scholar
Loggetto, Sandra Regina Google Scholar
Machado, Rodrigo Strehl Autor UNIFESP Google Scholar
Hernandes Granato, Celso Francisco Autor UNIFESP Google Scholar
Kawakami, Elisabete Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Hematol Ctr São Paulo
Abstract Helicobacter pylori and immune thrombocytopenic purpura (ITP) association is not well established in chronic ITP (cITP) in children, although the cure of thrombocytopenia in approximately half of H. pylori eradicated adult patients has been described. the aim of this study was to investigate the effect of H. pylori eradication on platelet (PLT) recovery in cITP children and adolescents through a randomized, controlled trial. A total of 85 children (mean age 11.4 years) with cITP were prospectively enrolled. Diagnosis of H. pylori was established by two locally validated tests, C-13-urea breath test and monoclonal stool antigen test. Twenty-two infected patients were identified, and randomly allocated into two groups: H. pylori treatment group (n = 11) and the non-intervention control group (n = 11). the control group was offered treatment if the thrombocytopenia persisted after the follow-up. At baseline, there were no differences regarding age, sex, duration of disease, and PLT count between groups. Sixty three of 85 patients were uninfected. PLT response was classified as complete response: PLT > 150 x 10(9) l(-1); partial response: PLT 50-150 x 10(9) l(-1), or an increase of 20-30 x 10(9) l(-1); no response: PLT < 50 x 10(9) l(-1) or an increase of <20 x 10(9) l(-1) after at least 6 months of follow-up. Complete response was observed in 60.0% (6/10, one excluded) H. pylori eradicated patients vs. 18.2% (2/11) in non-eradicated patients (p = 0.08; OR = 6.75) after 6-9 months of follow-up. Among uninfected patients, only 13.8% (8/58) presented complete response. Two non-treated controls were treated after 6-12 months of follow-up, and PLT response was observed in 61.5% (8/13) of H. pylori eradicated patients, and in 19.0% (11/58) of uninfected patients (p = 0.004). Cytotoxin associated gene A and vacuolating cytotoxin gene A IgG antibodies were present in almost all infected patients. Therefore, the study suggests that H. pylori eradication plays a role in the management of H. pylori infected cITP children and adolescents.
Keywords Adolescents
children
Helicobacter pylori
immune thrombocytopenia
immune thrombocytopenic purpura
Language English
Sponsor Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Date 2015-01-01
Published in Platelets. London: Informa Healthcare, v. 26, n. 4, p. 336-341, 2015.
ISSN 0953-7104 (Sherpa/Romeo, impact factor)
Publisher Informa Healthcare
Extent 336-341
Origin http://dx.doi.org/10.3109/09537104.2014.911836
Access rights Closed access
Type Article
Web of Science ID WOS:000354480200009
URI http://repositorio.unifesp.br/handle/11600/38621

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