Skip to main content

A case of severe pseudomembranous colitis diagnosed by colonoscopy after Helicobacter pylori eradication


A 65-year-old male was admitted for hemorrhagic gastric ulcer. Since anti-Helicobacter pylori-immunoglobulin G antibody tested positive, eradication therapy was administered using rabeprazole, amoxicillin, and clarithromycin. During hospitalization, colonoscopy showed normal colonic mucosa except for a polyp of the sigmoid colon. He was discharged 4 days after finishing eradication therapy, but fever up and diarrhea appeared on the following day. After re-admission, colonoscopy revealed multiple yellowish-white, small circular membranous elevations, and a diagnosis of pseudomembranous colitis was made. He was successfully treated by oral administration of vancomycin. Concomitant use of antibiotics and a proton pump inhibitor for a hospitalized patient is a risk for pseudomembranous colitis. However, H. pylori eradication therapy should be started at re-introduction of oral feeding in cases of bleeding ulcers because rebleeding can be mortal in patients in ‘poor general condition’. Physicians should consider pseudomembranous colitis as a diagnosis for the patients with diarrhea and high fever following H. pylori eradication therapy.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Uemura N, Okamoto S, Yamamoto S, et al. Helicobacter pylori infection and the development of gastric cancer. N Engl J Med. 2001;345:784–9.

    CAS  PubMed  Article  Google Scholar 

  2. Asaka M, Kato M, Takahashi S, et al. Guidelines for the management of Helicobacter pylori infection in Japan: 2009 revised edition. Helicobacter. 2010;15:1–20.

    CAS  PubMed  Article  Google Scholar 

  3. Kubo N, Kochi S, Ariyama I, et al. Pseudomembranous colitis after Helicobacter pylori eradication therapy. Kansenshogaku Zasshi. 2006;80:51–5 (in Japanese).

    PubMed  Google Scholar 

  4. Nakashima Y. A case of pseudomembranous colitis after eradication therapy for Helicobacter pylori. Jpn J Prim Care. 2004;27:203–4.

    Google Scholar 

  5. Hudson N, Brydon WB, Eastwood MA, et al. Successful Helicobacter pylori eradication incorporating a one-week antibiotic regimen. Aliment Pharmacol Ther. 1995;9:47–50.

    CAS  PubMed  Article  Google Scholar 

  6. Aoki T, Kataoka M, Sou Y, et al. A case of pseudomembranous colitis concomitant with toxic megacolon and paralytic ileus. Nihon Shokakibyo Gakkai Zasshi. 2012;109:1386–93 (in Japanese).

    PubMed  Google Scholar 

  7. Sogaard KK, Ejlertsen T, Schonheyder HC. Clostridium difficile 027-associated pseudomembranous colitis after short-term treatment with cefuroxime and cephalexin in an elderly orthopedic patient: a case report. BMC Res Notes. 2012;5:609.

    PubMed Central  PubMed  Article  Google Scholar 

  8. Villanueva-Saenz E, Herrera JT, Martinez-Hernandez Magro P. Toxic megacolon secondary to pseudomembranous colitis. Rev Gastroenterol Mex. 2001;66:141–5.

    CAS  PubMed  Google Scholar 

  9. Vanpoucke H, De Baere T, Claeys G, et al. Evaluation of six commercial assays for the rapid detection of Clostridium difficile toxin and/or antigen in stool specimens. Clin Microbiol Infect. 2001;7:55–64.

    CAS  PubMed  Article  Google Scholar 

  10. Pepin J, Valiquette L, Alary ME, et al. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003. CMAJ. 2004;171:466–72.

    PubMed Central  PubMed  Article  Google Scholar 

  11. McFarland LV, Mulligan ME, Kwork RY, et al. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320:204–10.

    CAS  PubMed  Article  Google Scholar 

  12. Thibaut A, Miller MA, Gaese C, et al. Risk factors for the development of Clostridium difficile-associated diarrhea during a hospital outbreak. Infect Control Hosp Epidemiol. 1991;12:345–8.

    Article  Google Scholar 

  13. Bliss DZ, Johnson S, Savik K, et al. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med. 1998;129:1012–9.

    CAS  PubMed  Article  Google Scholar 

  14. Kwok CS, Arthur AK, Anibueze CI, et al. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107:1011–9.

    CAS  PubMed  Article  Google Scholar 

  15. Cohen SH, Gerding DN, Johnson S, et al. Clinical practice for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol. 2010;31:431–55.

    PubMed  Article  Google Scholar 

  16. Malfertheiner P, Megraud F, O’Morain CA, European Helicobacter Study Group, et al. Management of Helicobacter pylori infection—the Maastricht IV/Florence consensus report. Gut. 2012;61:646–64.

    CAS  PubMed  Article  Google Scholar 

Download references


Conflict of Interest: Satoshi Sato, Daisuke Chinda, Kiyonori Yamai, Ryu Satake, Yasushi Soma, Tadashi Shimoyama, and Shinsaku Fukuda declare that they have no conflict of interest.

Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

Informed Consent: Informed consent was obtained from all patients for being included in the study.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Tadashi Shimoyama.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sato, S., Chinda, D., Yamai, K. et al. A case of severe pseudomembranous colitis diagnosed by colonoscopy after Helicobacter pylori eradication. Clin J Gastroenterol 7, 247–250 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Helicobacter pylori
  • Eradication
  • Pseudomembranous colitis