{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:40:17Z","timestamp":1792687217803,"version":"4.5.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T00:00:00Z","timestamp":1792627200000},"content-version":"vor","delay-in-days":86,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Ann Hematol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Helicobacter pylori (H. pylori) has been implicated in immune thrombocytopenia (ITP), but the magnitude and reliability of benefit from eradication therapy in randomized trials remain uncertain. We performed a PRISMA-guided, PROSPERO-registered (CRD420251149478) systematic review and meta-analysis restricted to randomized controlled trials (RCTs) comparing H. pylori eradication versus control in ITP. Random-effects models generated risk ratios (RRs) for categorical outcomes: complete response (CR), partial response (PR), overall response (CR\u2009+\u2009PR), no\/minimal response (NR), and 1-year relapse, and mean differences (MDs) for platelet-count change at approximately 6 months. Heterogeneity was assessed using I\u00b2 and \u03c4\u00b2. Robustness was evaluated using leave-one-out analyses and additional post hoc sensitivity analyses for clinically or statistically influential trials. Small-study effects were explored using funnel plots and Egger\/Begg tests when sufficient studies were available. Eight RCTs (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u2009297) across Asia and Latin America met inclusion. Eradication increased CR without statistical significance (RR 1.45, 95% CI 0.87\u20132.41; I\u00b2=40.9%) and did not change PR (RR 0.88, 0.57\u20131.36; I\u00b2=0%) or overall response (RR 1.04, 0.90\u20131.20; I\u00b2=35.9%). NR was significantly lower with eradication (RR 0.65, 0.49\u20130.85; I\u00b2=14.8%). Relapse at 1 year trended lower but was not significant (RR 0.49, 0.24\u20131.01; I\u00b2=0%). Platelet counts rose more after eradication at ~\u20096 months (MD\u2009+\u200961.9\u2009\u00d7\u200910\u2079\/L, 36.1\u201387.7; I\u00b2=74.9%). Leave-one-out analyses did not materially change the overall conclusions. In a post hoc sensitivity analysis excluding Tang 2013 from the platelet-change outcome because of unusually small reported SDs, the platelet-count benefit remained significant and heterogeneity decreased to I\u00b2=0%. Funnel plots and formal tests suggested small-study effects for CR and overall response, indicating that these estimates may be inflated; no\/minimal response showed no evidence of asymmetry. In randomized trials, H. pylori eradication in ITP was associated with a lower risk of no\/minimal response and a greater platelet-count increase, while effects on CR, PR, overall response, and relapse remained uncertain. Because CR and overall response showed evidence of small-study effects, the most robust categorical finding was the reduction in no\/minimal response. Larger, adequately powered trials are needed to define which patients are most likely to benefit and to confirm the durability of platelet response.\n                  <\/jats:p>","DOI":"10.1007\/s00277-026-07187-7","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T01:14:04Z","timestamp":1785201244000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Helicobacter pylori eradication for immune thrombocytopenia reduces non-response and raises platelet counts: Meta-analysis of randomized trials"],"prefix":"10.1007","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-2835-0429","authenticated-orcid":false,"given":"Moath","family":"Hattab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fathi","family":"Milhem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hammam","family":"Jallad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Suleiman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halla","family":"Albada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayman","family":"Khaled","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakeena","family":"Saife","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mira","family":"Hallak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Saife","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadi","family":"Abualhommos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Bdair","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"issue":"22","key":"7187_CR1","doi-asserted-by":"publisher","first-page":"3780","DOI":"10.1182\/bloodadvances.2019000812","volume":"3","author":"D Provan","year":"2019","unstructured":"Provan D, Arnold DM, Bussel JB, Chong BH, Cooper N, Gernsheimer T et al (2019) Updated international consensus report on the investigation and management of primary immune thrombocytopenia. Blood Adv 3(22):3780\u20133817","journal-title":"Blood Adv"},{"issue":"23","key":"7187_CR2","doi-asserted-by":"publisher","first-page":"3829","DOI":"10.1182\/bloodadvances.2019000966","volume":"3","author":"C Neunert","year":"2019","unstructured":"Neunert C, Terrell DR, Arnold DM, Buchanan G, Cines DB, Cooper N et al (2019) American Society of Hematology 2019 guidelines for immune thrombocytopenia. Blood Adv 3(23):3829\u20133866","journal-title":"Blood Adv"},{"issue":"16","key":"7187_CR3","doi-asserted-by":"publisher","first-page":"4822","DOI":"10.3390\/jcm11164822","volume":"11","author":"H Takeuchi","year":"2022","unstructured":"Takeuchi H, Okamoto A (2022) Helicobacter pylori infection and chronic immune thrombocytopenia. J Clin Med 11(16):4822","journal-title":"J Clin Med"},{"issue":"3","key":"7187_CR4","doi-asserted-by":"publisher","first-page":"714","DOI":"10.3748\/wjg.v20.i3.714","volume":"20","author":"M Kuwana","year":"2014","unstructured":"Kuwana M (2014) Helicobacter pylori-associated immune thrombocytopenia: clinical features and pathogenic mechanisms. World J Gastroenterol 20(3):714\u2013723","journal-title":"World J Gastroenterol"},{"key":"7187_CR5","doi-asserted-by":"publisher","first-page":"6090878","DOI":"10.1155\/2018\/6090878","volume":"2018","author":"BJ Kim","year":"2018","unstructured":"Kim BJ, Kim HS, Jang HJ, Kim JH (2018) Helicobacter pylori eradication in idiopathic thrombocytopenic purpura: a meta-analysis of randomized trials. 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J Clin Invest 118(8):2939\u20132949. https:\/\/doi.org\/10.1172\/JCI34496","journal-title":"J Clin Invest"}],"container-title":["Annals of Hematology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00277-026-07187-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00277-026-07187-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00277-026-07187-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:03:01Z","timestamp":1792684981000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00277-026-07187-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":19,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,11]]}},"alternative-id":["7187"],"URL":"https:\/\/doi.org\/10.1007\/s00277-026-07187-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7951511\/v1","asserted-by":"object"}]},"ISSN":["1432-0584"],"issn-type":[{"value":"1432-0584","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"assertion":[{"value":"26 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Not applicable. This study synthesized previously published aggregate data and did not involve collection of new human participant data.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The protocol was prospectively registered in PROSPERO (CRD420251149478). Reporting follows PRISMA 2020.","order":2,"name":"Ethics","label":"Protocol and registration","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"473"}}