Effect of Helicobacter Pylori eradication on patients with ITP: a meta-analysis of studies conducted in the Middle East

Seyed Mohammad Sadegh Pezeshki; Najmadin Saki; Mehran Varnaseri Ghandali; Alireza Ekrami; Arshid Yousefi Avarvand

doi:10.5045/br.2021.2020189

Quick links

Most Cited Most Read Ahead of Print Archives Go to E-submission

Original Article

Split Viewer

Blood Res 2021; 56(1):

Published online March 31, 2021

https://doi.org/10.5045/br.2021.2020189

Effect of Helicobacter Pylori eradication on patients with ITP: a meta-analysis of studies conducted in the Middle East

Seyed Mohammad Sadegh Pezeshki^1,2, Najmadin Saki¹, Mehran Varnaseri Ghandali³, Alireza Ekrami², Arshid Yousefi Avarvand²

Author Info. +

¹Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Science, ²Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, ³Department of Infectious Diseases, Razi Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

Correspondence to : Arshid Yousefi Avarvand, Ph.D.
Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Golestan St, Ahvaz 61357-15794, Iran
E-mail: arshid.yousefi5@gmail.com

Received: August 4, 2020; Revised: December 1, 2020; Accepted: February 23, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Go to

Abstract

Background
Immune thrombocytopenia (ITP) is a bleeding disorder. Helicobacter pylori is a Gram-negative bacterium that is presumed to be associated with ITP and therapeutic response of patients. To evaluate the effect of H. pylori eradication on platelet count of ITP patients, we analyzed the studies conducted on the association between H. pylori infection and response to therapy in ITP patients in Western Asia focusing on the Middle East region.
Methods
A systematic search of databases (PubMed/Medline, ISI Web of Science, Cochrane Central) and Google Scholar search engine results was conducted up until January 2020. The keywords included in the search were Helicobacter pylori and/or H. pylori, ITP and/or immune thrombocytopenia.
Results
Seven studies comprising a total of 228 H. pylori-infected patients (193 with successful eradication) were included in this study. The association between H. pylori eradication and ITP was expressed as odds ratios (OR) and 95% confidence intervals (CI). The findings showed that patients who received eradication treatment for H. pylori infection had significantly higher OR (OR, 8.83; 95% CI, 2.03‒38.35; P =0.004) than those in the non-eradicated group.
Conclusion
Our results indicate a significant therapeutic effect of H. pylori eradication on the platelet count of patients with chronic ITP. Given the inherent limitations of this study, including the small number of patients, further studies with more patients are recommended.

Keywords Helicobacter pylori, H. Pylori, ITP, Immune thrombocytopenia

Article

Original Article

Blood Res 2021; 56(1): 38-43

Published online March 31, 2021 https://doi.org/10.5045/br.2021.2020189

Effect of Helicobacter Pylori eradication on patients with ITP: a meta-analysis of studies conducted in the Middle East

Seyed Mohammad Sadegh Pezeshki^1,2, Najmadin Saki¹, Mehran Varnaseri Ghandali³, Alireza Ekrami², Arshid Yousefi Avarvand²

Correspondence to:Arshid Yousefi Avarvand, Ph.D.
Department of Laboratory Sciences, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Golestan St, Ahvaz 61357-15794, Iran
E-mail: arshid.yousefi5@gmail.com

Received: August 4, 2020; Revised: December 1, 2020; Accepted: February 23, 2021

Abstract

Keywords: Helicobacter pylori, H. Pylori, ITP, Immune thrombocytopenia

Abstract

Fig 1.

Download

Figure 1.Identification, screening, eligibility assessment, and final included studies.

Blood Research 2021; 56: 38-43https://doi.org/10.5045/br.2021.2020189

Fig 2.

Download

Figure 2.Odds ratios of the patients with eradication of H. Pylori.

Blood Research 2021; 56: 38-43https://doi.org/10.5045/br.2021.2020189

Fig 3.

Download

Figure 3.Evaluation of publication bias by funnel plot.

Blood Research 2021; 56: 38-43https://doi.org/10.5045/br.2021.2020189

Table 1 . Summary of the characteristic of the included studies..

Reference (country)	N (F/M) Age mean±SD or median (range)	Detection of HP infection (follow up period)	Duration of ITP (type of ITP relapse)	Platelet count at enrollment	Platelet after treatment	Response in all infected patients	Eradicated patients (non-eradicated patients)
Iran [18]	29.2±7.0 (18–46)	79 patients were infected & only 71 completed eradication	61 mo (6–210 mo)	58.32±17.74×10⁹/L (range, 31–96×10⁹/L)	Eradicated patients137.77×10⁹/L	Response in 30 eradicated patients	62
	29.2±7.0 (18–46)	79 patients were infected & only 71 completed eradication	Chronic		Eradicated patients137.77×10⁹/L	Response in 30 eradicated patients	9
	29.2±7.0 (18–46)	1 yr	NR		P<0.001	CR: 30	9
Iran [19]	30 (67/33)	5 patients were infected	NR	20×10⁹/L (10–30×10⁹/L)	81×10⁹/L (69–89×10⁹/L)	Response in 5 eradicated patients	5
	12 (9–16)	5 patients were infected	Chronic		81×10⁹/L (69–89×10⁹/L)	PR: 4	0
		1 yr	1 out of 5 eradicated patients (20%)		P=0.043	CR: 0
		1 yr	1 out of 5 eradicated patients (20%)		P=0.043	PR+CR: 4 patients
Iran [20]	52 (50/50 in 26 patients)	H. pylori eradication achieved in 89.5% (26/29)	NR	57.9×10⁹/L (22–96×10⁹/L)	104×10⁹/L (26–196×10⁹/L)	Response in 26 eradicated patients	26
	52 (50/50 in 26 patients)		NR		104×10⁹/L (26–196×10⁹/L)	CR: 15	3
	38 (17–71)		NR		P<0.001	PR: 0
	38 (17–71)	6 mo	NR		P<0.001	PR+CR: 15
Iran [21]	92 (53/47)	Only 47 patients remained after excluding other patients	2.2 mo (1–4.5 mo)	34.6×10⁹/L (21–48×10⁹/L)	52.8×10⁹/L (23–86×10⁹/L)	Response in 41 eradicated patients	41
	41 (19–71)		2.2 mo (1–4.5 mo)		52.8×10⁹/L (23–86×10⁹/L)	CR: 0	6
			Chronic		(P<0.001)	PR: 3
		6 mo	NR		(P<0.001)	PR+CR: 3
Pakistan [22]	197 (54.5/45.5 in 22 patient)	22 patients were infected	NR	53.36±24.5×10⁹/L	80.86±51.0×10⁹/L	Response in 22 infected patients	7
	197 (54.5/45.5 in 22 patient)	22 patients were infected	NR		80.86±51.0×10⁹/L	CR: 7	15
	43.18±12.5 yr	NR	NR		P=0.003	PR: 10
	43.18±12.5 yr	NR	NR		P=0.003	PR+CR: 17
Pakistan [23]	85 (62.3/37.6)	34 patients were infected	NR	48.56±21.7×10⁹/L	94.2±26.8×10⁹/L	Response in 34 eradicated patients	34
	Infected patients: 43.89±7.06	34 patients were infected	Chronic		94.2±26.8×10⁹/L	CR: 19	0
	Uninfected patients: 44.75±7.91	NR	NR		P=0.001	PR: 10
	Uninfected patients: 44.75±7.91	NR	NR		P=0.001	PR+CR: 29
Turkey [24]	34 (35.3/64.7)	20 patients were infected	NR	39.7±19.2×10⁹/L	164.2±63.2×10⁹/L	Response in 18 eradicated patients	18
	52.5 yr (range, 16–93)	20 patients were infected	Chronic		164.2±63.2×10⁹/L	CR: 5/18	2
		13 mo	NR		P<0.05	PR: 3/18
		13 mo	NR		P<0.05	PR+CR: 8

Abbreviations: CR, complete response; ITP, immune thrombocytopenia; NR, not reported; PR, partial response..

Table 2 . Random-effects model for pooling data..

Model	N of studies	Effect size and 95% interval			Test of null (2-tail)			Heterogeneity			Tau-squared

		Point estimate	Lower limit	Upper limit	z-value	P	q-value	df (Q)	P	I-squared	Tau squared	Standard error	Variance	Tau
Fixed	6	6.013	3.833	9.435	7.806	0.000	42.809	5	0.000	88.320	2.674	2.290	5.244	1.635
Random	6	8.830	2.033	38.355	2.907	0.004