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Development of corpus atrophic gastritis may be associated with Helicobacter pylori-related idiopathic thrombocytopenic purpura

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Abstract

Background

A strict correlation between Helicobacter pylori eradication and an increase in platelet count has previously been reported in patients with chronic idiopathic thrombocytopenic purpura (ITP). To clarify the pathogenesis of H. pylori-induced ITP and the factors predicting the platelet response to H. pylori eradication therapy, we evaluated the markers of atrophic gastritis in ITP patients.

Methods

The study population comprised 31 H. pylori-infected patients with chronic ITP. After undergoing upper gastrointestinal endoscopy and gastric biopsy, all patients received H. pylori eradication therapy. The effect of H. pylori eradication on the platelet count was evaluated for up to 6–54 months after the therapy. The degree of endoscopic gastric atrophy, histological parameters in the gastric mucosa, and serum pepsinogen (PG) levels were compared between platelet responders and nonresponders to the therapy.

Results

H. pylori was successfully eradicated in all patients and a platelet response was seen in 18 (58%) of these patients. The serum pepsinogen (PG) I/II ratio at pretreatment was significantly lower in responders than in nonresponders. The degree of endoscopic gastric atrophy was significantly more severe in responders than in nonresponders. Furthermore, the levels of histological parameters of activity, inflammation, and atrophy in the gastric corpus, but not in the gastric antrum, were significantly more severe in responders than in nonresponders,.

Conclusion

The development of corpus atrophic gastritis may be a suitable condition for inducing thrombocytopenia. Evaluation of the serum, endoscopic, and histological markers of atrophic gastritis may assist in selecting patients with ITP who are more likely to respond to H. pylori eradication therapy.

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References

  1. Suerbaum S, Michetti P. Helicobacter pylori infection. N Engl J Med. 2002;347:1175–86.

    Article  PubMed  CAS  Google Scholar 

  2. Gasbarrini A, Franceschi F, Tartaglione R, Landolfi R, Pola P, Gasbarrini G. Regression of autoimmune thrombocytopenic purpura after eradication of Helicobacter pylori. Lancet. 1998;352:878.

    Article  PubMed  CAS  Google Scholar 

  3. Franchini M, Cruciani M, Mengoli C, Pizzolo G, Veneri D. Effect of Helicobacter pylori eradication on platelet count in idiopathic thrombocytopenic purpura; a systematic review and meta-analysis. J Antimicrob Chemother. 2007;60:237–46.

    Article  PubMed  CAS  Google Scholar 

  4. Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, et al. Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut. 2007;56:772–81.

    Article  PubMed  CAS  Google Scholar 

  5. Takahashi T, Yujiri T, Shinohara K, Inoue Y, Sato Y, Fujii Y, et al. Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol. 2004;124:91–6.

    Article  PubMed  CAS  Google Scholar 

  6. Suzuki T, Matsushima M, Masui A, Watanabe K, Takagi A, Ogawa Y, et al. Effect of Helicobacter pylori eradication in patients with chronic idiopathic purpura—a randomized controlled trial. Am J Gastroenterol. 2005;100:1265–70.

    Article  PubMed  Google Scholar 

  7. Kodama M, Kitadai Y, Ito M, Kai H, Masuda H, Tanaka S, et al. Immune response to CagA protein is associated with improved platelet count after Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura. Helicobacter. 2007;12:36–42.

    Article  PubMed  CAS  Google Scholar 

  8. Bai Y, Wang Z, Bai X, Yu Z, Cao L, Zang Y, et al. Cross-reaction of antibody against Helicobacter pylori urease B with platelet glycoprotein IIIa and its significance in the pathogenesis of immune thrombocytopenic purpura. Int J Hematol. 2007;89:142–9.

    Article  Google Scholar 

  9. Veneri D, De Matteis G, Solero P, Federici F, Zunuso C, Guizzardi E, et al. Analysis of B- and T-cell clonality and HLA class II alleles in patients with idiopathic thrombocytopenic purpura: correlation with Helicobacter pylori infection and response to eradication treatment. Platelets. 2005;16:307–11.

    Article  PubMed  CAS  Google Scholar 

  10. Satoh T, Pandey JP, Okazaki Y, Asahi A, Kawakami Y, Ikeda Y, et al. Single nucleotide polymorphism of interleukin-1β associated with Helicobacter pylori infection in immune thrombocytopenic purpura. Tissue Antigens. 2009;73:353–7.

    Article  PubMed  CAS  Google Scholar 

  11. Suzuki T, Matsushima M, Shirakura K, Koike J, Masui A, Takagi T, et al. Association of inflammatory cytokine gene polymorphisms with platelet recovery in idiopathic thrombocytopenic purpura patients after the eradication of Helicobacter pylori. Digestion. 2008;77:73–8.

    Article  PubMed  CAS  Google Scholar 

  12. Ishiyama M, Teramura M, Iwabe K, Kato T, Motoji T. Clonally expanded T-cells in the peripheral blood of patients with idiopathic thrombocytopenic purpura and Helicobacter pylori infection. Int J Hematol. 2006;83:147–51.

    Article  PubMed  CAS  Google Scholar 

  13. Asahi A, Nishimoto T, Okazaki Y, Suzuki H, Masaoka T, Kawakami Y, et al. Helicobacter pylori eradication shifts monocyte Fcγ receptor balance toward inhibitory FcγRIIB in immune thrombocytopenic purpura patients. J Clin Invest. 2008;118:2939–49.

    PubMed  CAS  Google Scholar 

  14. Stasi R, Sarpatwari A, Segal JB, Osborn J, Evangelista ML, Cooper N, et al. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood. 2009;113:1231–40.

    Article  PubMed  CAS  Google Scholar 

  15. Sato R, Murakami K, Watanabe K, Okimoto T, Miyajima H, Ogata M, et al. Effect of Helicobacter pylori eradication on platelet recovery in patients with chronic idiopathic thrombocytopenic purpura. Arch Intern Med. 2004;164:1904–7.

    Article  PubMed  Google Scholar 

  16. George JN, Woolf SH, Raskob GR, Wasser JS, Aledort LM, Ballem PJ, et al. Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology. Blood. 1996;88:3–40.

    PubMed  CAS  Google Scholar 

  17. Samloff IM, Varis K, Ihamaki T, Siurala M, Rotter JI. Relationships among serum pepsinogen I, serum pepsinogen II, and gastric mucosal histology: a study in relatives of patients with pernicious anemia. Gastroenterology. 1982;83:204–9.

    PubMed  CAS  Google Scholar 

  18. Miki K, Ichinose M, Shimizu A, Huang SC, Oka H, Furihata C, Oka H, et al. Serum pepsinogens as a screening test of extensive chronic gastritis. Gastroenterol Jpn. 1987;22:133–41.

    PubMed  CAS  Google Scholar 

  19. Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy. 1969;3:87–97.

    Article  Google Scholar 

  20. Dixon MF, Genta RM, Yardley J, Correa P. Classification and grading of gastritis. The updated Sydney System. Am J Surg Pathol. 1996;20:1161–81.

    Article  PubMed  CAS  Google Scholar 

  21. Karpatkin S. Autoimmune (idiopathic) thrombocytopenic purpura. Lancet. 1997;349:1531–6.

    Article  PubMed  CAS  Google Scholar 

  22. Veneri D, Krampera M, Franchini M. High prevalence of sustained remission of idiopathic thrombocytopenic purpura after Helicobacter pylori eradication: a long-term follow up study. Platelets. 2005;16:117–9.

    Article  PubMed  CAS  Google Scholar 

  23. Satake M, Nishikawa J, Fukagawa Y, Akashi K, Okamoto T, Yoshida T, et al. The long-term efficacy of Helicobacter pylori eradication therapy in patients with idiopathic thrombocytopenic purpura. J Gastroenterol Hepatol. 2007;22:2233–7.

    Article  PubMed  CAS  Google Scholar 

  24. Emilia G, Luppi M, Zucchini P, Morselli M, Potenza L, Forghieri F, et al. Helicobacter pylori infection and chronic immune thrombocytopenic purpura: long-term results of bacterium eradication and association with bacterium virulence profile. Blood. 2007;110:3833–41.

    Article  PubMed  CAS  Google Scholar 

  25. Jackson SC, Beck P, Buret AG, O’Connor PM, Meddings J, Pineo G, et al. Long term platelet responses to Helicobacter pylori eradication in Canadian patients with immune thrombocytopenic purpura. Int J Hematol. 2008;88:212–8.

    Article  PubMed  Google Scholar 

  26. Tsumoto C, Toninaga K, Okazaki H, Tanigawa T, Yamagami Y, Watanabe K, et al. Long-term efficacy of Helicobacter pylori eradication in patients with idiopathic thrombocytopenic purpura: 7-year follow-up prospective study. Ann Hematol. 2009;88:789–93.

    Article  PubMed  CAS  Google Scholar 

  27. Ching CK, Wong BC, Kwok E, Ong L, Covacci A, Lam SK. Prevalence of CagA-bearing Helicobacter pylori strains detected by the anti-CagA assay in patients with ulcer disease and in controls. Am J Gastroenterol. 1996;91:949–53.

    PubMed  CAS  Google Scholar 

  28. Smoot DT, Mobley HLT, Chippendale GR, Lewison JF, Resau JH. Helicobacter pylori urease activity is toxic to human gastric epithelial cells. Infect Immun. 1990;58:1992–4.

    PubMed  CAS  Google Scholar 

  29. Fujimura K, Kuwana M, Kurata Y, Imamura M, Harada H, Sakamaki H, et al. Is eradication therapy useful as the first line of treatment in Helicobacter pylori-positive idiopathic thrombocytopenic purpura? Analysis of 207 eradicated chronic ITP cases in Japan. Int J Hematol. 2005;81:162–8.

    Article  PubMed  Google Scholar 

  30. Stasi R, Rossi Z, Stipa E, Amadori S, Newland AC, Provan D. Helicobacter pylori eradication in the management of patients with idiopathic thrombocytopenic purpura. Am J Med. 2005;118:414–9.

    Article  PubMed  Google Scholar 

  31. Ando K, Shimamoto T, Tauchi T, Ito Y, Kuriyama Y, Gotoh A, et al. Can eradication therapy for Helicobacter pylori really improve the thrombocytopenia in idiopathic thrombocytopenic purpura? Our experiment and a literature review. Int J Hematol. 2003;77:239–44.

    Article  PubMed  Google Scholar 

  32. Inaba T, Mizuno M, Take S, Suwaki K, Honda T, Kawai K, et al. Eradication of Helicobacter pylori increases platelet count in patients with idiopathic thrombocytopenic purpura. Eur J Clin Invest. 2005;35:214–9.

    Article  PubMed  CAS  Google Scholar 

  33. Suvajdzic N, Stankovic B, Artiko V, Cvejic T, Bulat V, Bakrac C, et al. Helicobacter pylori eradication can induce platelet recovery in chronic idiopathic thrombocytopenic purpura. Platelets. 2006;17:227–30.

    Article  PubMed  CAS  Google Scholar 

  34. Asahi A, Kuwana M, Suzuki H, Hibi T, Kawakami Y, Ikeda Y. Effects of a Helicobacter pylori eradication regimen on anti-platelet autoantibody response in infected and uninfected patients with idiopathic thrombocytopenic purpura. Haematologica. 2006;91:1436–7.

    PubMed  CAS  Google Scholar 

  35. Kawaguchi H, Haruma K, Komoto K, Yoshihara M, Sumii K, Kajiyama G. Helicobacter pylori infection is the major risk factor for atrophic gastritis. Am J Gastroenterol. 1996;91:959–62.

    PubMed  CAS  Google Scholar 

  36. Kuipers EJ, Uyterlinde AM, Pena AS, Roosendaal R, Pals G, Nelis GF, et al. Long-term sequelae of Helicobacter pylori gastritis. Lancet. 1995;345:1525–8.

    Article  PubMed  CAS  Google Scholar 

  37. Satoh K, Kimura K, Taniguchi Y, Yoshida Y, Kihira K, Takimoto T, et al. Distribution of inflammation and atrophy in the stomach of Helicobacter pylori-positive and -negative patients with chronic gastritis. Am J Gastroenterol. 1996;91:963–9.

    PubMed  CAS  Google Scholar 

  38. Ando T, Tsuzuki T, Mizuno T, Minami M, Ina K, Kusugami K, et al. Characteristics of Helicobacter pylori-induced gastritis and the effect of H. pylori eradication in patients with chronic idiopathic thrombocytopenic purpura. Helicobacter. 2004;9:443–52.

    Article  PubMed  Google Scholar 

  39. Negrini R, Savio A, Poiesi C, Appelmelk BJ, Buffoli F, Paterlini A, et al. Antigenic mimicry between Helicobacter pylori and gastric mucosa in the pathogenesis of body atrophic gastritis. Gastroenterology. 1996;111:655–65.

    Article  PubMed  CAS  Google Scholar 

  40. Claeys D, Faller G, Appelmelk BJ, Negrini R, Kirchner T. The gastric H+, K+-ATPase is a major autoantigen in chronic Helicobacter pylori gastritis with body mucosa atrophy. Gastroenterology. 1998;115:340–7.

    Article  PubMed  CAS  Google Scholar 

  41. Asaka M, Sugiyama T, Nobuta A, Kato M, Takeda H, Graham DY. Atrophic gastritis and intestinal metaplasia are strongly related to Helicobacter pylori infection and not to aging in Japan: results of a large multi-center study. Helicobacter. 2001;6:294–9.

    Article  PubMed  CAS  Google Scholar 

  42. Imai T, Kubo T, Watanabe H. Chronic gastritis in Japanese with reference to high incidence of gastric carcinoma. J Nat Cancer Inst. 1971;47:179–95.

    PubMed  CAS  Google Scholar 

  43. Kohli Y, Kato T, Suzuki K, Tada T, Fujiki N. Incidence of atrophic gastritis with age in Japan and Canada. Jpn J Med. 1987;26:158–61.

    Article  PubMed  CAS  Google Scholar 

  44. Campuzano-Maya G. Proof of an association between Helicobacter pylori and idiopathic thrombocytopenic purpura in Latin America. Helicobacter. 2007;12:265–73.

    Article  PubMed  Google Scholar 

  45. Rostami N, Keshtkar-Jahromi M, Rahnavardi M, Keshtkar-Jahromi M, Esfahani FS. Effects of eradication of Helicobacter pylori on platelet recovery in patients with chronic idiopathic thrombocytopenic purpura: a controlled trial. Am J Hematol. 2008;83:376–81.

    Article  PubMed  Google Scholar 

  46. Faller G, Kirchner T. Immunological and morphogenic basis of gastric mucosa atrophy and metaplasia. Virchows Arch. 2005;446:1–9.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Gastroenterology and General Medicine, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Oita, Yufu, 879-5593, Japan

    Ryugo Sato, Kazunari Murakami, Tadayoshi Okimoto, Koichiro Watanabe, Masaaki Kodama & Toshio Fujioka

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  1. Ryugo Sato
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  2. Kazunari Murakami
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  3. Tadayoshi Okimoto
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  4. Koichiro Watanabe
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Correspondence to Kazunari Murakami.

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Sato, R., Murakami, K., Okimoto, T. et al. Development of corpus atrophic gastritis may be associated with Helicobacter pylori-related idiopathic thrombocytopenic purpura. J Gastroenterol 46, 991–997 (2011). https://doi.org/10.1007/s00535-011-0416-8

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  • DOI: https://doi.org/10.1007/s00535-011-0416-8

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