Helicobacter pylori (H. pylori) is one of the most common chronic bacterial infections in humans, affecting half of world’s population. Therapy for H. pylori infection has proven to be both effective and safe. The one-week triple therapy including proton pump inhibitor, clarithromycin, and amoxicillin or metronidazole is still recommended as a first-line treatment to eradicate H. pylori infection in countries with low clarithromycin resistance. Generally, this therapy is well-tolerated, with only a few and usually minor side effects. However, rare but severe adverse effects such as pseudomembranous colitis have been reported, Clostridium difficile (C. difficile) infection being the main causative factor in all cases. We report the cases of two women who developed pseudomembranous colitis after a 1-wk triple therapy consisting of pantoprazole 20 mg bid, clarithromycin 500 mg bid, and amoxicillin 1 g bid to eradicate H. pylori infection. A limited colonoscopy showed typical appearance of pseudomembranous colitis, and the stool test for C. difficile toxins was positive. Rapid resolution of symptoms and negative C. difficile toxins were obtained in both patients with oral vancomycin. No relapse occurred during a four and eleven-month, respectively, follow up. These cases suggest that physicians should have a high index of suspicion for pseudomembranous colitis when evaluate patients with diarrhea following H. pylori eradication therapy.
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机译：幽门螺杆菌（H. pylori）是人类最常见的慢性细菌感染之一，影响了全球一半的人口。幽门螺杆菌感染的治疗已被证明既有效又安全。在克拉霉素耐药性较低的国家，仍推荐使用包括质子泵抑制剂，克拉霉素，阿莫西林或甲硝唑在内的为期一周的三联疗法作为根除幽门螺杆菌感染的一线治疗。通常，这种疗法具有良好的耐受性，仅具有很少且通常较小的副作用。然而，已经报道了罕见但严重的不良反应，例如假膜性结肠炎，艰难梭菌（C. difficile）感染是所有情况下的主要致病因素。我们报道了两名妇女在1周三联疗法后发展为假膜性结肠炎的情况，三联疗法包括20毫克pan托拉唑，500毫克克拉霉素，和1克阿莫西林以根除幽门螺杆菌感染。有限的结肠镜检查显示假膜性结肠炎的典型表现，艰难梭菌毒素的粪便测试为阳性。两位口服万古霉素的患者均可快速缓解症状，并获得艰难梭菌毒素阴性。分别在四个月和十一个月的随访中未发生复发。这些情况表明，在评估 H 后的腹泻患者时，医师应高度怀疑假膜性结肠炎。幽门螺杆菌根除疗法。
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