Abstract
Eradication of Helicobacter pylori usually consists of a 7-day course of triple therapy including metronidazole or amoxicillin plus clarithromycin plus a proton pump inhibitor. We report about a rare adverse event of Hp eradication in a patient with moderate chronic and moderate active pangastritis. Shortly after the end of treatment cholestatic hepatitis occurred which was most likely related to clarithromycin, perhaps enhanced by amoxicillin. Since liver dysfunction was self-limited, no further treatment was required. In summary, clinicians should be aware about the presented rare adverse event of Helicobacter pylori eradication treatment for a close monitoring of those patients and rapid management of acute liver failure.
Highlights
According to the current DGVS (German Association of Gastroenterologists) S3-guidelines eradication of Helicobacter pylori (Hp) is indicated in patients with gastric or duodenal ulcer and gastric marginal zone B-cell lymphoma of MALT-type
We report the case of a 64-year-old patient who presented with unclear elevation of liver enzymes
There are three reports indicating that intrahepatic cholestasis [3], acute liver injury and even liver failure [4,5] may be caused by amoxicillin alone
Summary
According to the current DGVS (German Association of Gastroenterologists) S3-guidelines eradication of Helicobacter pylori (Hp) is indicated in patients with gastric or duodenal ulcer and gastric marginal zone B-cell lymphoma of MALT-type (mucosa-associated lymphoid tissue). The list of drugs he was taken included 6 mg betahistine q.d., 150 mg allopurinol q.d., 25 mg carvedilol q.d., 80 mg valsartan b.i.d., and 25 mg hydrochlorothiazide q.d. Initial laboratory investigation showed increased levels for ASAT [67 U/L (normal ≤35)], ALAT [67 U/L (normal ≤45)], GGT [87 U/L (normal ≤55)], and bilirubin [22 μmol/L (normal < 20)] (Figure 1). Laboratory investigation showed further increased levels for ALAT [86 U/L] and GGT [185 U/L], and stably elevated levels for ASAT [59 U/L] and bilirubin [24 μmol/L] (Figure 1). Laboratory investigation showed further increased levels for ASAT [73 U/L], ALAT [1351 U/L] and GGT [344 U/L], with bilirubin level remaining unchanged [21 μmol/L] (Figure 1). Laboratory investigation in our outpatient department showed decreased levels for ASAT [40 U/L], ALAT [54 U/L], and GGT [119 U/L] (Figure 1). Physician demonstrated further reduction of liver enzymes with the exception of bilirubin
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