Childhood Idiopathic Thrombocytopenic Purpura and Helicobacter pylori

Idiopathic thrombocytopenic purpura (ITP) is considered an autoimmune disease that lowers blood platelets due to autoantibody infiltration against the platelets. The precise cause of this is unclear, but in recent years a high prevalence of Helicobacter pylori (HP) infection has been reported in adu...

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Published inThe Japanese Journal of Pediatric Hematology Vol. 17; no. 5; pp. 413 - 417
Main Authors SHIRAHATA, Akira, FUJISAWA, Kohji, OHARA, Akira, SAKAI, Michio
Format Journal Article
LanguageJapanese
Published THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 2003
特定非営利活動法人 日本小児血液・がん学会
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ISSN0913-8706
1884-4723
DOI10.11412/jjph1987.17.413

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Abstract Idiopathic thrombocytopenic purpura (ITP) is considered an autoimmune disease that lowers blood platelets due to autoantibody infiltration against the platelets. The precise cause of this is unclear, but in recent years a high prevalence of Helicobacter pylori (HP) infection has been reported in adult patients with ITP. Furthermore, the platelet count increases after HP eradication in many HP-infected ITP patients, suggesting that HP is involved as a causative agent in 20-40% of adult ITP cases. The present study therefore examined HP infection in chronic childhood ITP cases. Serum anti-HP IgG antibody, anti-HP IgG antibody in urine, stool HP antigen and 13C urea breath test were measured in 40 subjects, but HP infection was verified in only a small percentage (two subjects; 5.0%). Neither of these subjects underwent bacterium eradication therapy in the survey stage, so the relationship with ITP pathology remains a topic for future study. In the diagnosis and treatment of HP infection in children, it is necessary to fully bear in mind the low sensibility to serum anti-HP IgG antibody testing and the 13C urea breath test, as well as the prevalence of clarithromycin-resistant HP as compared to adults.
AbstractList Idiopathic thrombocytopenic purpura (ITP) is considered an autoimmune disease that lowers blood platelets due to autoantibody infiltration against the platelets. The precise cause of this is unclear, but in recent years a high prevalence of Helicobacter pylori (HP) infection has been reported in adult patients with ITP. Furthermore, the platelet count increases after HP eradication in many HP-infected ITP patients, suggesting that HP is involved as a causative agent in 20-40% of adult ITP cases. The present study therefore examined HP infection in chronic childhood ITP cases. Serum anti-HP IgG antibody, anti-HP IgG antibody in urine, stool HP antigen and 13C urea breath test were measured in 40 subjects, but HP infection was verified in only a small percentage (two subjects; 5.0%). Neither of these subjects underwent bacterium eradication therapy in the survey stage, so the relationship with ITP pathology remains a topic for future study. In the diagnosis and treatment of HP infection in children, it is necessary to fully bear in mind the low sensibility to serum anti-HP IgG antibody testing and the 13C urea breath test, as well as the prevalence of clarithromycin-resistant HP as compared to adults.
Idiopathic thrombocytopenic purpura (ITP) is considered an autoimmune disease that lowers blood platelets due to autoantibody infiltration against the platelets. The precise cause of this is unclear, but in recent years a high prevalence of Helicobacter pylori (HP) infection has been reported in adult patients with ITP. Furthermore, the platelet count increases after HP eradication in many HP-infected ITP patients, suggesting that HP is involved as a causative agent in 20-40% of adult ITP cases. The present study therefore examined HP infection in chronic childhood ITP cases. Serum anti-HP IgG antibody, anti-HP IgG antibody in urine, stool HP antigen and 13C urea breath test were measured in 40 subjects, but HP infection was verified in only a small percentage (two subjects; 5.0%). Neither of these subjects underwent bacterium eradication therapy in the survey stage, so the relationship with ITP pathology remains a topic for future study. In the diagnosis and treatment of HP infection in children, it is necessary to fully bear in mind the low sensibility to serum anti-HP IgG antibody testing and the 13C urea breath test, as well as the prevalence of clarithromycin-resistant HP as compared to adults. 特発性血小板減少性紫斑病 (ITP) は, 血小板に対する自己抗体により血小板減少をきたす自己免疫性疾患と考えられている.その原因の詳細は今なお不明であるが, 最近の報告では, 成人のITP患者の半数以上にHelicobacter pylori (HP) 感染を認め, さらに除菌治療に成功した約半数のHP感染者で血小板数が増加することから, 成人ITPの20~40%にHPが病因として関与することが示唆されている.そこで今回われわれは, 小児慢性ITP症例を対象にHPの感染状況を検討した.対象は40例で, 血清抗HP IgG抗体, 尿中抗HP IgG抗体, 尿素呼気試験等を測定したが, HP感染が証明されたのはわずか2例 (5.0%) と低率であり, その2例とも調査段階で除菌療法未施行例であったため, ITPの病態との関連は今後の検討課題として残された.なお, 小児のHP感染の診断および治療にあたっては, 成人と比較して, 血清抗HP IgG抗体検査や尿素呼気試験の感度が低いことや, clarithromycin耐性HPが多いこと等を十分考慮する必要がある.
Author SAKAI, Michio
OHARA, Akira
FUJISAWA, Kohji
SHIRAHATA, Akira
Author_FL 白幡 聡
藤沢 康司
小原 明
酒井 道生
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  organization: The 1st Department of Pediatrics, Toho University School of Medicine
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  fullname: SAKAI, Michio
  organization: Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health
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References 9) 加藤精一 : Helicobacter pylori感染の診断と治療のガイドライン.小児科診療55 : 1335-1340, 2002
5) Kohda K, Kuga T, Kogawa K, et al : Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura. Br J Haematol 118 : 584-588, 2002
4) Emilia G, Longo G, Luppi M, et al : Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood 97 : 812-814, 2001
13) 坊岡美奈, 奥田真珠美, 宮代英吉 : 便中Helicobacter pylori抗原をスタンダードとした尿中抗Helicobacter pylori IgG抗体の有用性の検討. 日本小児科学会雑誌106 : 768-769, 2002
2) De Luis DA, Varela C, de la Calle H, et al : Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. J Clin Gastroenterol 26 : 259-263, 1998
11) 奥田真珠美, 宮代英吉, 石井侃, 他 : 小児期のHelicobacter pylori感染症の診断法と除菌治療.化学療法の領域17 : 478-484, 2001
10) 加藤精一, 小林昭夫, 杉山敏郎, 他 : 小児のHehcobacter pylori除菌療法に関するガイドライン (案) の提唱. 日本小児栄養消化器病学会雑誌11 : 173-176, 1997
7) Emilia G, Luppi M, Morselli M, et al : Helicobacter pylori infection and idiopathic thrombocytopenic purpura. Br J Haematol 118 : 1190-1200, 2002
14) Kato S, Fujimura S, Udagawa H, et al : Antibiotic resistance of Helicobacter pylori strains in Japanese children. J Clin Microbiol 40 : 649-653, 2002
6) Jarque I, Andreu R, Llopis I, et al : Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura. Br J Haematol 115 : 1002-1003, 2001
16) Bamfold KB, Andersen L : Hpst response. Curr Opin Gastroenterol 13 (suppl 1) : 25-30, 1997
15) Gold BD, Colletti RB, Abbott M, et al : Helicobacter pylori infection in children : Recommendation for diagnosis and treatment. J Pediatr Gastroenterol Nutr 31 : 490-497, 2000
12) 加藤精一 : 小児における便中抗原検査 (HpSA) の有用性の検討 : 多施設共同研究. 第6回日本小児H.pylori研究会抄録集p.12, 2002
3) Gasbarrini A, Franceschi F, Tartaglione R, et al : Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori. Lancet 352 : 878, 1998
8) 加藤精一, 今野武津子, 豊田茂, 他 : 第27回日本小児栄養消化器病学会講演抄録集, p. 52, 2000
1) Zentilin P, Savarino V, Garnero A, et al : Is Helicobacter pylori infection a risk factor for disease severity in rheumatoid arthritis? Gastroenterology 116 : 503-504, 1999
17) Sonnenblick M, Rosin A : Cardiotoxicity of interferon. Chest 99 : 557-561, 1991
References_xml – reference: 12) 加藤精一 : 小児における便中抗原検査 (HpSA) の有用性の検討 : 多施設共同研究. 第6回日本小児H.pylori研究会抄録集p.12, 2002
– reference: 4) Emilia G, Longo G, Luppi M, et al : Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood 97 : 812-814, 2001
– reference: 10) 加藤精一, 小林昭夫, 杉山敏郎, 他 : 小児のHehcobacter pylori除菌療法に関するガイドライン (案) の提唱. 日本小児栄養消化器病学会雑誌11 : 173-176, 1997
– reference: 6) Jarque I, Andreu R, Llopis I, et al : Absence of platelet response after eradication of Helicobacter pylori infection in patients with chronic idiopathic thrombocytopenic purpura. Br J Haematol 115 : 1002-1003, 2001
– reference: 1) Zentilin P, Savarino V, Garnero A, et al : Is Helicobacter pylori infection a risk factor for disease severity in rheumatoid arthritis? Gastroenterology 116 : 503-504, 1999
– reference: 8) 加藤精一, 今野武津子, 豊田茂, 他 : 第27回日本小児栄養消化器病学会講演抄録集, p. 52, 2000
– reference: 15) Gold BD, Colletti RB, Abbott M, et al : Helicobacter pylori infection in children : Recommendation for diagnosis and treatment. J Pediatr Gastroenterol Nutr 31 : 490-497, 2000
– reference: 9) 加藤精一 : Helicobacter pylori感染の診断と治療のガイドライン.小児科診療55 : 1335-1340, 2002
– reference: 17) Sonnenblick M, Rosin A : Cardiotoxicity of interferon. Chest 99 : 557-561, 1991
– reference: 14) Kato S, Fujimura S, Udagawa H, et al : Antibiotic resistance of Helicobacter pylori strains in Japanese children. J Clin Microbiol 40 : 649-653, 2002
– reference: 2) De Luis DA, Varela C, de la Calle H, et al : Helicobacter pylori infection is markedly increased in patients with autoimmune atrophic thyroiditis. J Clin Gastroenterol 26 : 259-263, 1998
– reference: 16) Bamfold KB, Andersen L : Hpst response. Curr Opin Gastroenterol 13 (suppl 1) : 25-30, 1997
– reference: 5) Kohda K, Kuga T, Kogawa K, et al : Effect of Helicobacter pylori eradication on platelet recovery in Japanese patients with chronic idiopathic thrombocytopenic purpura and secondary autoimmune thrombocytopenic purpura. Br J Haematol 118 : 584-588, 2002
– reference: 3) Gasbarrini A, Franceschi F, Tartaglione R, et al : Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori. Lancet 352 : 878, 1998
– reference: 7) Emilia G, Luppi M, Morselli M, et al : Helicobacter pylori infection and idiopathic thrombocytopenic purpura. Br J Haematol 118 : 1190-1200, 2002
– reference: 11) 奥田真珠美, 宮代英吉, 石井侃, 他 : 小児期のHelicobacter pylori感染症の診断法と除菌治療.化学療法の領域17 : 478-484, 2001
– reference: 13) 坊岡美奈, 奥田真珠美, 宮代英吉 : 便中Helicobacter pylori抗原をスタンダードとした尿中抗Helicobacter pylori IgG抗体の有用性の検討. 日本小児科学会雑誌106 : 768-769, 2002
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Snippet Idiopathic thrombocytopenic purpura (ITP) is considered an autoimmune disease that lowers blood platelets due to autoantibody infiltration against the...
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SubjectTerms 13C urea breath test
anti-HP IgG antibodies
eradication therapy
Helicobacter pylori
idiopathic thrombocytopenic purpura
Title Childhood Idiopathic Thrombocytopenic Purpura and Helicobacter pylori
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