Does Helicobacter Pylori Co-Infection Contribute to Hepatitis C Virus-Associated Thrombocytopenia in Egyptian Patients?

Title: Does Helicobacter Pylori Co-Infection Contribute to Hepatitis C Virus-Associated Thrombocytopenia in Egyptian Patients?

Authors: Nadia E Zaki, Dalia A Nafea, Seham M Elbeih, Wafaa H Elsheikh, Nehad S Ibrahim, Amal R Mansour

DOI: http://dx.doi.org/10.18535/jmscr/v4i10.09

Abstract

Background: Despite the strong association between HCV and H. pylori co infection and the well-known relation between H. pylori and immune thrombocytopenia, there is no available literature concerning the relation between HCV-associated thrombocytopenia and H. pylori.

Objectives: The aim of the present study was to investigate the frequency of H. pylorico infection in Egyptian patients with chronic HCV infection with and without thrombocytopenia and whether anti-H.pylori therapy would improve thrombocytopenia in those patients.

Methods: 160 patients with chronic HCV infection including 80 patients with thrombocytopenia and 80 patients with normal platelet counts were enrolled in the study. Patients with hypersplenism, advanced liver disease or receiving antiviral therapy were excluded. H. pylori antigen was detected in the stools by rapid test. Triple therapy was administered to 30 H. pylori-positive thrombocytopenic patients for two weeks.

Results: H. pylori was detected in 123 out of 160 (76.90%) HCV patients. Moreover, a significantly greater number of thrombocytopenic patients (67/80) had positive stool test for H.pylori compared to HCV patients with normal platelet counts (56/80);{p=0.039}. 19 out of 30 patients responded significantly to anti-helicobacter therapy with increase or normalization of platelet counts (p=0.001).H.pylori was eradicated in all of those 19 subjects.

Conclusion: To our knowledge, this is the first study to suggest a strong association between HCV-associated thrombocytopenia and H. pylori. The significant platelet response to eradication of the bacterium may open the door for anti-Helicobacter therapy as an adjuvant in the management of this difficult disease. Therefore, screening for H. pylori infection and an attempt to eradicate the bacterium in positive cases seems appropriate in all patients with HCV-associated thrombocytopenia at diagnosis. Randomized placebo-controlled clinical trials are warranted.

Key Words: HCV, H. pylori, thrombocytopenia, Anti-helicobacter therapy, Egypt.

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Corresponding Author

Nadia El_Sayed Zaki, MD, PhD

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