Pseudomembranous colitis after eradication of Helicobacter pylori infection with a triple therapy

H.pylori (H.p.) infection of the gastric mucosa is causally related to chronic gastritis, peptic ulcer disease, MALT-lymphoma and gastric cancer. There is also an evidence for a link between the H.p.-infection and non-ulcer dyspepsia and even extragastric diseases. The number of patients treated against H.p. infection is expanding. Although in the last years the PPI-based triple therapies have been considered to be effective and safe, in some patients, however, severe side-effects may occur.

We report on a 86 year old female patient, who received a one-week triple eradication therapy (metronidazole 3x400 mg/die, clarithromycin 2x250 mg/die and omeprazole 2x20 mg/die) because of non-ulcer dyspepsia. A few days after the eradication treatment, she developed profuse watery and bloody diarrhea and abdominal pain with distention. In stool specimens Clostridium difficile toxin was detected. A colonoscopy showed typical features of antibiotic associated pseudomembranous colitis. Until now, only few reports concerning this complication have been published and the frequency of the complication in patients eradicated for H.p. is unknown. The potential risk factors to develop this condition have not been clarified. Since the complication may be potentially lethal, this severe side-effect of the usually well-tolerated triple-therapy has to be considered in patients suffering from profuse diarrhea and abdominal pain after eradication therapy.