Evidence map›Paper›PMID 42911235›Full record

SynthesisAnnals of hematology2026

Helicobacter pylori eradication for immune thrombocytopenia reduces non-response and raises platelet counts: Meta-analysis of randomized trials.

Moath Hattab, Fathi Milhem, Hammam Jallad, Mahmoud Suleiman, Halla Albada, Ayman Khaled, Sakeena Saife, Mira Hallak, Sarah Saife, Fadi Abualhommos and 1 more

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In one paragraph

Synthesis in Annals of hematology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Moath HattabDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine. MoathJHattab@Gmail.com.ORCID http://orcid.org/0009-0005-2835-0429
Fathi MilhemDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Hammam JalladDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Mahmoud SuleimanDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Halla AlbadaDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Ayman KhaledDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Sakeena SaifeDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Mira HallakDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Sarah SaifeDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Fadi AbualhommosDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.
Mohammad BdairDepartment of Medicine, Faculty of Medicine and Allied Medical Sciences, An-Najah National University, Nablus, P400, Palestine.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

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 + PR), no/minimal response (NR), and 1-year relapse, and mean differences (MDs) for platelet-count change at approximately 6 months. Heterogeneity was assessed using I² and τ². 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 = 297) across Asia and Latin America met inclusion. Eradication increased CR without statistical significance (RR 1.45, 95% CI 0.87-2.41; I²=40.9%) and did not change PR (RR 0.88, 0.57-1.36; I²=0%) or overall response (RR 1.04, 0.90-1.20; I²=35.9%). NR was significantly lower with eradication (RR 0.65, 0.49-0.85; I²=14.8%). Relapse at 1 year trended lower but was not significant (RR 0.49, 0.24-1.01; I²=0%). Platelet counts rose more after eradication at ~ 6 months (MD + 61.9 × 10⁹/L, 36.1-87.7; I²=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 I²=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.

Indexed as

Helicobacter InfectionsHelicobacter pyloriPurpura, Thrombocytopenic, IdiopathicAnti-Bacterial AgentsHumansPlatelet CountRandomized Controlled Trials as TopicAnti-Bacterial AgentsAntibioticsEradication therapyHelicobacter pyloriImmune thrombocytopeniaImmunologyPlatelet

Identifiers

PMID42911235

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.