Can Helicobacter pylori (H. pylori) treatment induce diarrhea?

Helicobacter pylori Treatment and Diarrhea

Yes, Helicobacter pylori treatment commonly induces diarrhea, affecting approximately 21-41% of patients during the first week of treatment due to antibiotic-induced disruption of normal gut microbiota. 1

Incidence and Mechanism

• Diarrhea is one of the most common adverse effects of H. pylori eradication therapy, with incidence rates ranging from 24% to 36.27% in patients not receiving probiotics 1
• The primary mechanism is antibiotic-associated disruption of the normal gut microbiota, which alters intestinal function and can lead to diarrhea 1
• In some cases, the diarrhea can be mild and self-limiting, as seen in only 2 out of 29 patients (7%) in one study using clarithromycin-amoxicillin dual therapy 2
• In rare but serious cases, H. pylori treatment can lead to Clostridium difficile colitis, a more severe form of antibiotic-associated diarrhea 3

Risk Factors and Severity

• Standard triple therapy (clarithromycin, proton pump inhibitor, and amoxicillin or metronidazole) is associated with significant rates of adverse events, including diarrhea 1
• Bismuth quadruple therapy and non-bismuth quadruple therapy can also cause diarrhea, though the rates may vary 1
• The risk of diarrhea may be higher in certain populations, such as elderly patients who may have altered gut microbiota or reduced intestinal function 4
• The severity of diarrhea ranges from mild (not requiring discontinuation of therapy) to severe (requiring treatment interruption or additional interventions) 1, 2

Prevention and Management Strategies

• Probiotic supplementation significantly reduces the risk of diarrhea during H. pylori eradication therapy, with a pooled odds ratio of 0.21 1
• Multi-strain probiotics have shown particular efficacy in preventing antibiotic-associated diarrhea during H. pylori treatment 1, 5
• Specific strains such as Lactobacillus-containing probiotics and Bifidobacterium longum have demonstrated effectiveness in reducing treatment-related side effects 1
• The Maastricht IV/Florence Consensus Report acknowledges that certain probiotics show promising results as adjuvant treatment in reducing side effects of H. pylori therapy 1

Clinical Implications

• Diarrhea during H. pylori treatment can reduce patient compliance, potentially leading to incomplete eradication and treatment failure 1
• When selecting an H. pylori treatment regimen, clinicians should consider the potential for diarrhea, especially in patients with pre-existing gastrointestinal conditions 1
• Adjunctive use of probiotics should be considered as a standard approach to reduce the risk of diarrhea and improve patient compliance 1, 5
• Patients should be informed about the possibility of diarrhea as a side effect and instructed to report severe or persistent symptoms, as they may indicate complications such as C. difficile infection 3

Monitoring and Follow-up

• Patients should be monitored for diarrhea during H. pylori treatment, particularly during the first week when the risk is highest 1
• If severe diarrhea develops, especially with symptoms such as fever, abdominal pain, or bloody stools, testing for C. difficile should be considered 3
• For mild diarrhea, continuing the treatment with the addition of probiotics may be sufficient 1, 5
• For severe diarrhea or confirmed C. difficile infection, appropriate treatment (such as metronidazole or vancomycin) should be initiated promptly 3