Journal List > Korean J Gastroenterol > v.56(4) > 1006720

Kwon, Lee, Kim, Lee, Kim, Jung, Jeong, Kim, and Kim: Antibiotics-associated Diarrhea and Other Gastrointestinal Abnormal Responses Regarding Helicobacter pylori Eradication

Abstract

Background/Aims

Helicobacter pylori (H. pylori) is closely related with a wide range of gastrointestinal disease. One-week triple therapy is currently considered as the golden standard for the treatment of H. pylori infection. However, gastrointestinal abnormal responses are major pitfalls in such regimen. The aim of this study was to identify symptoms, frequency and severity of antibiotics-associated gastrointestinal abnormal responses during H. pylori eradication therapy.

Methods

Sixty-seven patients with H. pylori infection between September 2005 and March 2006 were included. After 1 week of H. pylori eradication triple therapy (rabeprazol 10 mg, clarithromycin 500 mg, amoxicillin 1 g bid), we evaluated gastrointestinal abnormal responses (diarrhea, bloating, constipation, abdominal pain, borborygmus, flatulence, stool frequency, belching, and nausea) and severities every week for 4 weeks.

Results

The incidence of diarrhea was the highest in week 1, which was 41.28% (n=28) and the lowest in week 4, which was 9.52% (n=6) and decreased from week 1 to week 4 with statistical significance (p<0.0001). The most common gastrointestinal abnormal responses were associated with flatulence in week 1 (n=21, 31.34%), week 2 (n=21, 33.33%) and abdominal distention in week 3 (n=16, 25.40%), week 4 (n=15, 23.81%). Most of gastrointestinal abnormal responses were mild, and the most common symptom with higher than moderate grade was abdominal pain (n=4, 40.00%) in week 1. Alcohol consumption and coexisting medical illness were not associated with diarrhea (p=0.0852, 0.9009 respectively).

Conclusions

H. pylori eradication therapy is commonly associated with antibiotics-associated gastrointestinal abnormal responses, which may result in antibiotics intolerance and H. pylori eradication failure. Even though those symptoms are not so severe, we have to consider the gastrointestinal abnormal responses associated with H. pylori eradication, especially diarrhea.

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Table 1.
Baseline Characteristics of Study Group
Study group (n=67)
Age (Mean± SD) 44.24±10.25
Sex (male/female) 31/36
Past disease history (%)
Yes 44 (65.67)
No 23 (34.33)
Recent disease history (%)
Yes 10 (14.93)
No 57 (85.07)
Medication within 2 weeks (%)
Yes 8 (11.94)
No 59 (88.06)
Table 2.
Inciden nce of Loo ose Stool/Diar rrhea (%)
Week 1 Week 2 Week 3 Week 4
Incidence (%) 41.28
(28/67)
22.22
(14/63)
11.11
(7/63)
9.52
(6/63)
Table 3.
Frequency of Loose Stool/Diarrhea (%)
Week 1 Week 2 Week 3 Week 4
Frequency (Mean± SD) 2.46±1.82 2.93±2.37 2.14±1.77 1.67±1.21
Table 4.
Incidence of H. pylori Eradication Associated Gastrointestinal Side-Effects (%)
Week 1 Week 2 Week 3 Week 4
Constipation 5
(7.46)
11
(17.46)
11
(17.46)
10
(15.87)
Bloating 19
(28.36)
18
(28.57)
16
(25.40)
15
(23.81)
Abdominal pain 10
(14.93)
8
(12.70)
8
(12.70)
5
(7.94)
Borborygmus 18
(26.87)
13
(20.63)
8
(12.70)
7
(11.11)
Flatulence 21
(31.34)
21
(33.33)
15
(23.81)
12
(19.05)
Stool frequency 19
(28.36)
15
(23.81)
6
(9.52)
4
(6.35)
Belching 13
(19.40)
18
(28.57)
15
(23.81)
7
(11.11)
Nausea 14
(20.90)
9
(14.29)
9
(14.29)
6
(9.52)
Table 5.
Symptom Grade of H. pylori Eradication Associated Gastrointestinal Side-Effects (Week 1)
Mild (%) Moderate (%) Severe (%)
Constipation 5 (100.00) 0 (0.00) 0 (0.00)
Bloating 17 (89.47) 2 (10.53) 0 (0.00)
Abdominal pain 6 (60.00) 4 (40.00) 0 (0.00)
Borborygmus 15 (88.24) 2 (11.76) 0 (0.00)
Flatulence 17 (94.44) 1 (5.56) 0 (0.00)
Stool frequency 13 (81.25) 2 (12.50) 1 (6.25)
Belching 13 (100.00) 0 (0.00) 0 (0.00)
Nausea 11 (84.62) 1 (7.69) 1 (7.69)
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