Pseudomembranous colitis associated with a triple therapy for Helicobacter pylori eradication

Area of Science:

• Gastroenterology
• Infectious Diseases
• Microbiology

Background:

• Helicobacter pylori (H. pylori) infection affects half the global population, with standard triple therapy recommended for eradication.
• This therapy, typically a one-week course of a proton pump inhibitor, clarithromycin, and amoxicillin/metronidazole, is generally safe and effective.
• However, rare severe adverse events, including pseudomembranous colitis linked to Clostridium difficile (C. difficile) infection, can occur.

Observation:

• Two women developed pseudomembranous colitis following a one-week triple therapy for H. pylori eradication.
• Symptoms included diarrhea, and diagnostic colonoscopy revealed characteristic pseudomembranous colitis.
• Stool tests confirmed the presence of C. difficile toxins in both patients.

Findings:

• Oral vancomycin treatment resulted in rapid symptom resolution and negative C. difficile toxin tests.
• Both patients experienced no relapse during follow-up periods of four and eleven months, respectively.
• These cases highlight a rare but serious complication of H. pylori eradication therapy.

Implications:

• Physicians should maintain a high index of suspicion for pseudomembranous colitis in patients presenting with diarrhea post-H. pylori eradication.
• Early diagnosis and appropriate treatment, such as with oral vancomycin, are crucial for managing this adverse effect.
• This underscores the importance of monitoring for C. difficile infection following antibiotic treatment for H. pylori.