Helicobacter pylori Eradication in Idiopathic Thrombocytopenic Purpura: A Meta-Analysis of Randomized Trials

Table 1

Summary of the six included studies.

First author (year); Country [ref]

Number of ITP pts

Detection of Hp infection

Number of Hp (+) pts

Randomization

Number of pts

M/F

Mean age (yr) (SD or range)

Duration of ITP (yr)

Platelet at enrollment (×10^9/L)

Platelet after 6 mo of Tx (×10^9/L)

Response (CR + PR)

Relapse at 1 year

Jadad score

Suzuki (2005); Japan [16]

36

UBT or histology

25 (69.4%)

Eradication

13

5/8

57.4 ± 15.0

5.8 ± 7.2

54.7 ± 26.9

114.5 ± 90.5

6 (46.2%)

NA

2

Noneradication (observation)

12

5/7

56.2 ± 7.8

4.6 ± 5.2

48.4 ± 22.1

48.1 ± 26.0

0 (0%)

NA

Tsutsumi (2005); Japan [17]

25

Anti-Hp antibody

17 (68%)

Eradication

9

2/7

60.3

NA

NA

NA

6 (66.7%)

2 (33.3%)

2

Noneradication (PPI)

8

3/5

63.3

NA

NA

NA

5 (62.5%)

2 (40%)

Li (2009); China [18]

NA

UBT

93

Eradication + PD

51

27/24

6.7 ± 2.4

NA

NA

NA

45 (88.2%)

11 (21.6%)

1

Noneradication (PD)

42

22/20

5.8 ± 2.7

NA

NA

NA

37 (88.1%)

17 (40.5%)

Treepongkaruna (2009); Thailand [19]

55

UBT

16 (29.1%)

Eradication + PD

7

3/4

11.0

3.4 (1.7–6.9)

23.0 (3.0–84.0)

NA

1 (14.3%)

NA

2

Noneradication (PD)

9(8)

4/5

10.8

5.1 (1.2–9.5)

34.0 (3.0–86.0)

NA

1 (12.5%)

NA

Tang (2013); China [20]

92

UBT

68 (73.9%)

Eradication ± PD

34

NA

NA (child)

NA

14.8 ± 0.4

160.4 ± 1.0

26 (76.5%)

NA

2

Noneradication (±PD)

34

NA

NA (child)

NA

15.1 ± 0.3

80.6 ± 1.1

20 (58.8%)

NA

Brito (2015); Brazil [21]

85

UBT or stool Ag test

22 (25.9%)

Eradication ± PD

11

6/5

12.7 (4.9–17.5)

5 (1–8)

35.0 (1–145)

128 ± 73

7 (63.6%)

NA

2

Noneradication (±PD)

11

5/6

10.5 (5.8–17.7)

3 (0.7–11)

47 (8–139)

63 ± 44

4 (36.4%)

NA

ITP: idiopathic or immune thrombocytopenia purpura; Hp: Helicobacter pylori; UBT: ¹³C-urea breath test; pts: patients; yr: years; mo: months; SD: standard deviation; PPI: proton-pump inhibitor, PD: prednisone or prednisolone; Tx: treatment; CR: complete platelet response; PR: partial platelet response; NA: not available. One patient was withdrawn due to massive gastrointestinal bleeding, requiring high-dose prednisolone. Overall response criteria: Suzuki: platelet count increased by more than 50 × 10⁹/L 6 months after eradication therapy; Tsutsumi: platelet count with a net increase greater than 30 × 10⁹/L or a 50% increase in platelet count with a net increase of 10 × 10⁹/L but less than 30 × 10⁹/L; Li: platelet count with a net increase greater than 30 × 10⁹/L; Treepongkaruna: platelet count more than 100 × 10⁹/L sustaining for at least 3 months; Tang: platelet count more than 50 × 10⁹/L or platelet count with a net increase greater than 30 × 10⁹/L; Brito: platelet increase greater than 20–30 × 10⁹/L.