Revisiting the Role of Helicobacter Pylori in Immune Thrombocytopenia: Insights from a Tertiary Care Centre in India.

Immune thrombocytopenia (ITP) is an acquired autoimmune disorder with multifactorial etiologies, including possible infectious triggers such as Helicobacter pylori. The clinical benefit of H. pylori eradication in ITP remains variable across populations. We undertook this study to investigate the prevalence of H. pylori in ITP patients and its correlation with treatment response following eradication therapy in Indian settings. This prospective observational study included 135 patients with ITP (aged > 12 years) at a tertiary care institute in North India. The diagnosis of ITP was confirmed through peripheral blood smear and/or bone marrow examination. H. pylori infection was detected using stool antigen ELISA. All patients received standard-of-care treatment for ITP and 14-day eradication therapy for H. pylori. Clinical and hematological responses were monitored at follow-up. The mean age was 30.6 years, with 67.8% female patients. Chronic ITP constituted 60% of cases. H. pylori infection was detected in 27 (20%) patients, most commonly with chronic ITP. Platelet response was seen in 74.1% of H. pylori-positive patients, which was not significantly different from the general ITP population (69%, p = 0.58). No significant predictors of response were identified. H. pylori detection and eradication did not result in significantly improved outcomes in ITP patients in our cohort. However, due to the non-immunosuppressive nature and favourable cost-effectiveness of its therapy, eradication can be tried in ITP patients.