الفهرس 
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Abstract
Helicobacter pylori is a gram-negative bacterium which naturally colonises gastric mucosa and causes chronic active and chronic persistent gastritis in both adults and children. Almost half of the world’s population is estimated to be infected with H. pylori, and it is a major risk factor for several gastroduodenal diseases, including gastric ulcer, duodenal ulcer, gastric mucosa-associated lymphoid tissue (MALT) lymphoma, and distal gastric cancer
Helicobacter pylori infection also associated with the pathogenesis of extradigestive disorders, including hematologic, such as iron deficiency anemia, and autoimmune disorders, such as pernicious anemia, autoimmune neutropenia , Schönlein–Henoch purpura, and Immune thrombocytopenic purpura (ITP).
Immune thrombocytopenia is a disorder caused by antiplatelet antibodies which lead to an accelerated destruction of platelets and an inhibition of the production of platelets. ITP is the most common cause of thrombocytopenia in children.
Infection , whether viral or bacterial , plays a key role in the development of ITP. Infection intiates the disease, but its persistence is not thought to be required for development or persistence of ITP.
The role of helicobacter pylori in the development of ITP is not clear.Some studies support while other studies negates the role of helicobacter pylori in ITP.
The aim of the present study was to study the frequency of helicobacter pylori infection in children with chroinc ITPand to describe its relationship with epidemiological features, clinical presentations, disease course and treatment modalities.
The present study was conducted on 38 patients with chroinc ITP, and 38 age and sex matched normal controls.Criteria of case inclusion included thrombocytopenia for more than 12 months , negative anti-nuclear antibodies ,negative anti double stranded DNA antibodies and bone marrow examination consistent with ITP.cases were excluded if they were treated for helicobacter pylori within one year ,or treated with antibiotics or proton pump inhiptors within the previous four weeks of recruitment.
For all patients included in the study, full history was obtained including history suggestive of helicobacter pylori infection, compelte physical examination stressing on examination of the patient’s skin for brusies, purpuric spots,petechiae, evidence of bleeding from nose ,mouth or other parts of the body and examination of the liver and spleen.Investigations included CBC,bone marrow examination at diagnosis and helicobacter pylori antigen in stool by enzyme immunoassay.
We collected data about clinical presentation, laboratory findings, treatment and course of the disease in these patients
Our results showed that
1. There was no significant difference in age and sex between chroinc ITP cases and healthy control.
2. Adolescents are more likely to develop chronic disease than younger children, with a mean age of 10.14 ± 3.89 years (range: 4 years – 17 years).
3. Chroinc ITP more common in females with female to male ratio of 1.5:1.
4. patients with history of preceding upper respiratory tract infection more commonly developed chronic ITP,(28.9% of our patients).
5. Cutaneous bleeding was present in 100% of our patients. Mucosal bleeding (26.3%) was mainly in the form of epistaxis and bleeding gums and less commonly as GIT or genitourinary bleeding. We didn’t report any cases of ICH during the study period.
6. Helicobacter pylori infection is more common in chroinc ITP cases (39.5%) than healthy control(13.2%).
7. When comparing H.pylori positive group with H.pylori negative group among chroinc ITP cases positive patients showed more severe thrombocytopenia and severe clinical picture,than negative patients platlets were,15×1000/ miccroliter (5–45×1000/miccroliter) and 44×1000/ miccroliter (12–114×1000/ miccroliter) respectively.
8. Multivariate logistic regression of potential predictors of chronic ITP done showed significant association between infection with H. pylori and chronic ITP. (p=.0033), with an odds ratio (OR) of 3.000 (95%CI: 1.090 – 8.254).