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

References

Corresponding Author

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.

References

1. He Y, Yan W, Coito C, Li Y, Gale M Jr, Katze MG. The regulation of hepatitis C virus (HCV) internal ribosome-entry site-mediated translation by HCV replicons and nonstructural proteins. J Gen Virol 2003; 84: 535-43.

2. Mohamoud YA1, Mumtaz GR, Riome S, Miller D, Abu-Raddad LJ. The epidemic-ology of hepatitis C virus in Egypt: a systematic review and data synthesis. BMC Infect Dis 2013;13:288.

3. Lavanchy D. Evolving epidemiology of hepatitis C virus. ClinMicrobiolinfect 2011; 17(2): 107-15.

4. Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterol 2007; 13(17): 2436-41.

5. Hunt RH, Xiao SD, Megraud F, Leon-Barua R, Bazzoli F. Helicobacter pylori in developing countries. World Gastroent-erology Organization Global Guidelines. August 2010.

6. GangireddyVGR, Kanneganti PC, Sridhar S, TallaS, Coleman T. Management of thrombocytopenia in advanced liver disease. Can J Gastroenterol Hepatol 2014; 28(10): 558-64.

7. Peck-Radosavljevic M, Zacherl J, Meng YG, et al. Is inadequate Thrombopoietin production a major cause of thromboc-ytopenia in cirrhosis of the liver?J Hepatol1997; 27: 127–31.

8. Iga D, Tomimatsu M, Endo H, Ohkawa SI, Yamada O. Improvement of thrombocyt-openia with disappearance of HCV RNA in patients treated by interferon- alpha therapy: possible etiology of HCV-associated immune thrombocytopenia. Eur J Haematol 2005, 75:417–423.

9. Peck-Radosavljevic M.Thrombocytopenia in liver disease. Can J Gastroenterol 2000;14(Suppl D):60D-66D.

10. De Almeida AJ, Campos-de-Magalha˜es M, De MeloMarcal OP, Brandao-Mello CE,Okawa MY, De Oliveira RV, et al. Hepatitis C virus associated thrombocytopenia: Acontrolled prospe-ctive, virological study. Ann Hematol 2004;83:434–40.

11. Kajihara M, Kato S, Okazaki Y, et al. Arole of autoantibody-mediated platelet destruction in thrombocytopenia inpatients with cirrhosis.Hepatology2003; 37: 1267–76.

12. Suerbaum S, Michetti P.Helicobater pylori infection. N Engl J Med 2002; 347: 1175-86.

13. Franchini M, Cruciani M, Mengoli C, et al. 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.

14. Scandellari R, Allemand E, Vettore S, Plebani M, Randi ML, Fabris F. Platelet response to Helicobacter pylori eradication therapy in adult chronic idiopathic thrombocytopenic purpura seems to be related to the presence of anticytotoxin-associated gene A antibodies. Blood Coagul Fibrinolysis 2009;20: 108-113.

15. Arnold M, Bernotas A, Nazi I, et al. Platelet count response to H. pylori treatment in patients with immune thrombocytopenic purpura with and without H. pylori infection: a systematic review. Haematologica 2009; 94: 759-762.

16. Hassan EH, Saleem M, Seif SM, Hegazy AE, et al. Detection of Helicobacter-pyloriin hepatic tissueof patientswith chronic hepatitis C and hepatocellular carcinoma: (Immunohistochemical Studi-es). JASMR 2010; 5(2): 115–21.

17. Prell C, Osterrieder S, Lottspeich C, et al. Improved Performance of a Rapid Office-Based Stool Test for Detection of Helicobacter pylori in Children before and after Therapy. J ClinMicrobiol 2009; 47: 3980-4.

18. Franceschi F, Zuccalà G, RoccarinaD, Gasbarrini A.Clinical effects of Helicob-acter pylori outside the stomach. Nat Rev Gastroenterol Hepatol 2014;11: 234–42

19. El-Masry M, El-Shahat M, Badra G, et al. H.pylori and Hepatitis C virus coinfection in Egyptian patients. J Global Infect Dis 2010; 2:4-9.

20. Mohammad MA, Hussein L, Coward A, Jackson SJ. Prevalence of Helicobacter pylori infection among Egyptian children: impact of social background and effect on growth.Public health Nutr 2008;11 (3): 230-36.

21. Abdel-atti E, Masoud B, andAbouelnour E. Helicobacter Pylori Infection In HCV Infected Patients:Prevalence And Its Relation To Endoscopic Features. Menou-fiya Medical Journal 2011; 24(2): 83-94

22. Pellicano R, Leone N, Berrutti M, Cutufia MA, et al. Helicobacter pylori seropreva-lence in hepatitis C virus positive patients with cirrhosis. Journal of Hepatology 2000; 33: 648–50.

23. Kim DJ, Kim HY, Kim SJ, Hahn TH et al. Helicobacter pylori Infection and Peptic Ulcer Disease in Patients with Liver Cirrhosis. The Korean Journal of Internal Medicine 2008; 23:16-21.

24. Auroux J1, Lamarque D,Roudot-Thoraval F, Deforges L, et al. Gastroduodenal ulcer and erosions are related to portal hypertensive gastropathy and recent alcohol intake in cirrhotic patients.Dig Dis Sci 2003;48(6):1118-23.

25. Sung H, Chang M, Saab S. Management of Hepatitis C Antiviral Therapy Adverse Effects. CurrHep Rep 2011; 10(1): 33-40.

26. Faranoush M, Noorbakhsh S, Mehrvar A, Tabatabae Z. Role of H. pylori Infection (Serology, PCR) in Chronic Idiopathic Thrombocytopenic Purpura in an Endemic Country: A Case Control Study, Tehran, IRAN. J AIDS Clin Res 2013; 4(5):1-4.

27. Shaikh KH, Ahmed S, Ayyub M, Anwar J. Association of Helicobacter Pylori infection with Idiopathic Thrombocyt-openic Purpura. JPMA 2009; 59:660.

28. Tag HS, Lee HS, Jung S-H, Kim B-K, et al. Effects of Helicobacter pylori eradication in patients with immune thrombocytopenic purpura. Korean J Hematol 2010; 45 (2): 127-32.

29. Umemura T1, Muto H, Tanaka E, Matsumoto A, et al. Anti-Helicobacter pylori seropositivity: influence on severity and treatment response in patients with chronic hepatitis C. J Viral Hepat 2007;14(1):48-54.

Abstract

References

Corresponding Author

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

Frequency of Publication

Submission of Articles

Search