Certain infections can increase your risk of developing immune thrombocytopenia (ITP), including Helicobacter pylori (H. pylori). Although not every case of ITP develops after an infection, H. pylori has been associated with the condition. Your doctor may ask whether you’ve ever had H. pylori while diagnosing ITP.

Experts aren’t quite sure how an H. pylori infection may trigger or cause ITP, but they have some evidence-based theories. We’ll talk about those in this article, plus how H. pylori eradication therapy might help people with ITP after an H. pylori infection.

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How Might H. Pylori Be Connected to ITP?

H. pylori appears to alter the immune system in some ways, which may increase the risk of the immune system removing platelets from your blood. Here are a few leading theories on how an H. pylori infection might lead to ITP.

Antibodies Attacking the Body’s Platelets

One theory on the connection between H. pylori and ITP is known as molecular mimicry. When you’re infected with H. pylori, your immune system develops antibodies that are meant to find and destroy the bacteria by recognizing antigens, which are substances the immune system can identify and react to.

Experts believe that your immune system might mistake molecules on the surfaces of your own platelets for H. pylori antigens. Your immune system then attacks your own platelets, leading to a low platelet count. They believe the same process happens when human immunodeficiency virus (HIV) causes ITP.

Overuse of Platelets

Some strains of H. pylori may cause platelet aggregation, which means platelets clumping together. This is normally a natural part of the healing process — platelets are supposed to bind together to help stop bleeding.

However, H. pylori might cause platelets to clump together too much in blood vessels in the stomach. This may reduce the number of circulating platelets, which might explain how ITP can develop after an H. pylori infection.

More research is needed to determine which strains of H. pylori might cause platelet aggregation leading to chronic ITP.

Reducing Immune System Regulation

Normally, your immune system has mechanisms in place to stop it from overreacting and attacking your own tissues. An H. pylori infection might deactivate certain parts of the immune system that normally keep it in check, allowing your immune system to create antibodies that target and destroy platelets.

When Should People With ITP Be Tested for H. Pylori?

If you’ve been diagnosed with ITP, your doctor might suggest being tested for H. pylori if any of the risk factors apply to you. Some people are at a higher risk of experiencing an H. pylori infection than others, like people who live in developing countries.

While anyone can be infected if they come into contact with H. pylori bacteria, you may be at an increased risk if you:

• Share eating utensils or food
• Have chronic swelling or thinning of the stomach lining
• Don’t have access to clean drinking water
• Live in close quarters with many other people
• Have a family history of stomach ulcers or stomach cancer

Since H. pylori doesn’t cause symptoms most of the time, it’s more helpful to test based on risk factors than symptoms. Recommendations for H. pylori testing might vary based on where you live.

How Doctors Diagnose H. Pylori

If you have ITP and your doctor has decided to test you for H. pylori, they may do so using several different testing methods. Tests for H. pylori look for evidence of H. pylori bacteria in your system even if it doesn’t cause any symptoms. Your doctor might use one or more of the following tests.

Stool Tests

Stool tests can look for antigens that come from an H. pylori infection. Other stool tests look for gene changes that might cause an H. pylori infection to resist treatment with antibiotics.

Breath Tests

Breath tests for H. pylori involve swallowing a solution that contains a substance called urea. If you have an H. pylori infection, the bacteria react to the urea and release a gas called carbon dioxide. You then blow into a bag so that a device can measure the carbon dioxide molecules being released.

Endoscopy

An upper GI endoscopy involves guiding a lighted camera down your throat and into your stomach. It can help find peptic ulcers or gastritis caused by H. pylori. Doctors can also use it to gather a tissue sample from your stomach for a biopsy.

How Eradication Therapy Can Help

If you have H. pylori, your doctor might recommend eradication therapy to clear the infection. Doctors now choose H. pylori treatment based on factors such as local antibiotic resistance and, when available, antibiotic susceptibility testing.

Treatment usually combines several medicines, such as antibiotics and a medicine that reduces stomach acid. Some regimens also include bismuth, a substance that protects the lining of your stomach.

In most cases, doctors recommend taking two antibiotics at the same time to treat H. pylori. This can help prevent H. pylori from resisting antibiotic treatment.

Triple therapy for H. pylori usually involves one proton pump inhibitor (PPI), plus two antibiotics. Quadruple therapy involves the use of a PPI, two antibiotics, and a bismuth preparation. The exact recommendations can vary, but it’s important to follow your doctor’s instructions closely and complete any antibiotics that you start.

Eradication Therapy as ITP Treatment

Research shows that eradication therapy for H. pylori can help increase platelet counts and may support ITP treatment. Eradication therapy can increase platelet counts in some people who have both H. pylori infection and ITP.

However, some large studies have suggested that more severe ITP may not be as responsive to eradication therapy for H. pylori. More research is needed to look at long-term platelet counts and ITP relapse rates.

After treatment, doctors recommend testing again to make sure the infection is gone. This test is usually done at least four weeks after treatment ends. Some medicines, including PPIs, PCABs (medicines that reduce stomach acid), antibiotics, and bismuth, may need to be stopped for a period before testing because they can affect the test results.