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JAC Advance Access originally published online on June 7, 2007
Journal of Antimicrobial Chemotherapy 2007 60(2):237-246; doi:10.1093/jac/dkm195
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Systematic reviews

Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura: a systematic review and meta-analysis

Massimo Franchini1,*, Mario Cruciani2, Carlo Mengoli3, Giovanni Pizzolo4 and Dino Veneri4

1 Immuno-Hematology and Transfusion Center, City Hospital, Verona, Italy 2 Center of Preventive Medicine, HIV Outpatient Clinic, Verona, Italy 3 Department of Histology, Microbiology, and Medical Biotechnology, University of Padua, Padua, Italy 4 Department of Clinical and Experimental Medicine, Section of Hematology, University of Verona, Verona, Italy

Received 18 March 2007; returned 10 April 2007; revised 3 May 2007; accepted 7 May 2007

* Correspondence address. Servizio di Immunoematologia e Trasfusione—Centro Emofilia, Ospedale Policlinico, Piazzale L. Scuro, 10, 37134 Verona, Italy. Tel: +39-045-8073610; Fax: +39-045-8073612; E-mail: massimo.franchini{at}azosp.vr.it or mfranchini{at}univr.it

Background: There is a debate in the recent literature about the effect of Helicobacter pylori eradication on platelet count in patients with idiopathic thrombocytopenic purpura (ITP). In order to clarify this controversial issue, we performed a systematic review with meta-analysis of the available literature.

Methods: The meta-analytic comparison was focused on the difference in the platelet count increase between the experimental arm (H. pylori-infected patients who responded to eradication therapy) and each control arm (H. pylori-infected patients who failed to respond to eradication therapy; H. pylori-infected patients who did not receive eradication therapy and H. pylori-negative patients) and was expressed as weighted mean difference (WMD). Moreover, in order to explain the heterogeneity, a meta-regression model was fitted with arm-level covariates.

Results: Data involving 788 ITP patients were collected from 17 articles (16 studies with a prospective cohort design and 1 randomized trial). There was a statistically significant difference in the increase in platelet count in patients in whom eradication was successful compared with control groups [WMD, 40.77 x 109/L (95% CI, 20.92–60.63) compared with untreated patients; 52.16 (95% CI, 34.26–70.05) compared with patients who failed eradication and 46.35 (95% CI, 27.79–64.91) compared with H. pylori-negative patients]. Moreover, in the meta-regression model, the success of H. pylori eradication was highly significant as an explanatory variable for platelet count increase.

Conclusions: Our analysis shows a strict correlation between H. pylori eradication and increase in platelet count. However, due to intrinsic limits in the design of the studies analysed, further evidence from randomized clinical trials is required to confirm the effect of eradication treatment on platelet count.

Keywords: bacterium , therapy , ITP , thrombocytopenia


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