INTRODUCTION
Immune (idiopathic) thrombocytopenic purpura (ITP) is an acquired
disease characterized by a temporary or permanent decrease in the
platelet count that results from the effects of immune–mediated
anti–platelet antibodies (1). Its prevalence in adults is approximately
5–10/100.000 and it is more common among females in the adult age
group. It is usually associated with a chronic progression and an
elevated risk of bleeding due to the severity of thrombocytopenia (2,3).
Thrombocytopenia may be induced by antibodies that are produced in
response to pathogen antigens and cross–react with platelets in certain
infections, which mainly include viral infections but also consist of
bacterial infections. Particularly, lipopolysaccharides in bacteria are
reported to bind to the platelet membrane and trigger platelet
phagocytosis (4). Similarly, although no mechanism has been proposed to
explain how Helicobacter pylori (H. pylori) could be involved in
the pathogenesis of immune–mediated platelet destruction, the role of
bacterial factors such as the cytotoxin–associated gene A (CagA)
protein are currently being investigated (5).
The relationship between H. pylori infection and ITP was first
defined in 1998 by Gasbarrini et al. in a study where they reported a
high platelet count in 8 of their 11 ITP patients (6). Since then,
numerous studies on H. pylori eradication in ITP have been
published. However, it is still controversial whether or not H.
pylori eradication always increases the platelet count in patients
diagnosed with ITP. Comprehensive reviews suggest that eradication
therapy would need to be considered if a H. pylori infection is
detected in patients with typical ITP (7). Studies in the literature
have generally focused on the effects of the eradication of H.
pylori infection on increasing the platelet count in ITP patients and
the effects of H. pylori positivity on the response to the
standard first–line ITP treatment are not clear. The present study aims
to determine whether or not the response to the first–line treatment is
affected by H. pylori –positive and –negative states in patients
diagnosed with ITP.