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Original Article

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Blood Res 2021; 56(1):

Published online March 31, 2021

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

© The Korean Society of Hematology

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

Seyed Mohammad Sadegh Pezeshki1,2, 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

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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

Copyright © The Korean Society of Hematology.

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

Seyed Mohammad Sadegh Pezeshki1,2, Najmadin Saki1, Mehran Varnaseri Ghandali3, Alireza Ekrami2, Arshid Yousefi Avarvand2

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

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

Fig 1.

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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.

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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.

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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 enrollmentPlatelet after treatmentResponse in all infected patientsEradicated patients
(non-eradicated patients)
Iran [18]29.2±7.0 (18–46)79 patients were infected & only 71 completed eradication61 mo (6–210 mo)58.32±17.74×109/L (range, 31–96×109/L)Eradicated patients137.77×109/LResponse in 30 eradicated patients62
29.2±7.0 (18–46)Chronic9
1 yrNRP<0.001CR: 30
Iran [19]30 (67/33)5 patients were infectedNR20×109/L (10–30×109/L)81×109/L (69–89×109/L)Response in 5 eradicated patients5
12 (9–16)ChronicPR: 40
1 yr1 out of 5 eradicated patients (20%)P=0.043CR: 0
PR+CR: 4 patients
Iran [20]52 (50/50 in 26 patients)H. pylori eradication achieved in 89.5% (26/29)NR57.9×109/L (22–96×109/L)104×109/L (26–196×109/L)Response in 26 eradicated patients26
NRCR: 153
38 (17–71)NRP<0.001PR: 0
6 moPR+CR: 15
Iran [21]92 (53/47)Only 47 patients remained after excluding other patients2.2 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 patients41
41 (19–71)CR: 06
Chronic(P<0.001)PR: 3
6 moNRPR+CR: 3
Pakistan [22]197 (54.5/45.5 in 22 patient)22 patients were infectedNR53.36±24.5×109/L80.86±51.0×109/LResponse in 22 infected patients7
NRCR: 715
43.18±12.5 yrNRNRP=0.003PR: 10
PR+CR: 17
Pakistan [23]85 (62.3/37.6)34 patients were infectedNR48.56±21.7×109/L94.2±26.8×109/LResponse in 34 eradicated patients34
Infected patients: 43.89±7.06ChronicCR: 190
Uninfected patients: 44.75±7.91NRNRP=0.001PR: 10
PR+CR: 29
Turkey [24]34 (35.3/64.7)20 patients were infectedNR39.7±19.2×109/L164.2±63.2×109/LResponse in 18 eradicated patients18
52.5 yr (range, 16–93)ChronicCR: 5/182
13 moNRP<0.05PR: 3/18
PR+CR: 8

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

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

ModelN of studiesEffect size and 95% intervalTest of null (2-tail)HeterogeneityTau-squared
Point estimateLower limitUpper limitz-valuePq-valuedf (Q)PI-squaredTau squaredStandard errorVarianceTau
Fixed66.0133.8339.4357.8060.00042.80950.00088.3202.6742.2905.2441.635
Random68.8302.03338.3552.9070.004

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