Sir,
We read the great paper by Abdollahi et al. entitled “Is Helicobacter pylori infection a risk factor for idiopathic thrombocytopenic purpura (ITP) in children?” In the recent issue of Annals of African Medicine.[1] Regarding this article, some critical points are worth considering which are listed in below. ITP is an autoimmune disease identified by increased platelet destruction caused by antiplatelet autoantibodies. H. pylori successfully colonizes the human gastric epithelium of more than 50% world population.[2,3,4] There is a long list of extradigestive diseases that suspected to be linked with H. pylori colonization in the human stomach.[5]
In this paper, authors suggested that urea breath test (UBT) is recommended for testing the infection. UBT administration in adults seems likely possible, but due to the ethical issue and other difficulty in children, it seems that another interventions are needed. Consequently, current recommendation cannot be practically suitable for ITP children patients
Supposing, eradication of H. pylori is accepted as a new strategy for ITP patients; now, the challenging question would be the “is this bacterial elimination actually cost-effective?” So far, it has been asserted that screening and treatment for H. pylori is cost-effective only in peptic ulcer and gastric cancer patients. In addition, because of lacking data on local prevalence of this bacterium, this totally eradication may be not feasible
Notably, in the current study by Abdollahi et al., small numbers of children were selected, as generally accepted, investigations with larger numbers of participants will be necessary to fix such direct conclusion.[1] It is now firmly established that in clinical trials concerning H. pylori and any kind of extradigestive disorders, we need to have adequate sample size.
Broadly defined, H. pylori is a smart human pathogen that it can easily subvert immune response to establish lifelong infection. Since such a large number of infected individuals, global eradication of this bacterium is not practically possible. Moreover, prescribing inefficient antibiotics can result in increasing rate of antibiotic resistance. Finally, it is clear that H. pylori clearance and reduced chance of associated diseases call for a prophylactic vaccine which is preventive, safe, and cheap.
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Conflicts of interest
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Acknowledgments
The contents of this review article are the sole responsibility of the author and necessarily represent personal perspective.
References
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