The indirect toxic effect of antibiotics on the liver and biliary system is known through toxic products of the transformation of antibiotics in the body (metabolites). Some metabolites bind to liver substances (glutathione, etc.) and reduce the toxicity of antibiotic breakdown products and improve their excretion from the liver with bile. In this case, the bile may become viscous, and stagnation of bile in the gallbladder may be observed with the formation of suspension and flakes (i.e., bile sludge), which are risk factors and early signs of stone formation in the gallbladder.
Patient K., 40 years old, consulted a gastroenterologist about periodic aching pain in the right hypochondrium, heaviness after eating, and rarely bitterness in the mouth. The patient has been suffering from these sensations for several years; these sensations are provoked by long breaks in eating. Heredity is not burdened.
Effect of antibiotics. Objectively
- satisfactory condition,
- sclera and visible mucous membranes of normal color,
- the abdomen participates in breathing, is painless on palpation in all parts, gall bladder symptoms are negative,
- liver at the edge of the costal arch.
The patient is suspected of having a violation of the contractile function of the gallbladder (dyskinesia). To clarify what dyskinesia is, an ultrasound examination of gallbladder function (cholecystokinetic test) with a test breakfast (sorbitol) was prescribed.
Diagnosis and treatment of bitterness in the mouth
If the bitterness in the mouth is constant, consultation with a specialist is necessary. In this case we are talking about a gastroenterologist. Since the treatment is mainly complex, consultation with other doctors may be required, namely a gynecologist, endocrinologist or psychotherapist.
After examining the patient and collecting anamnesis, the doctor may prescribe additional laboratory and instrumental research methods, which include:
- General analysis and blood biochemistry;
- blood test for hormones;
- general urine analysis;
- ultrasound examination of the gastrointestinal tract;
- X-ray and FGSD.
Based on the examination results, the specialist will prescribe treatment for bitterness in the mouth. The course of therapy is strictly individual, taking into account the patient’s condition and the course of the disease.
Ultrasound results
Ultrasound of the gallbladder dated January 12, 2019: the shape is irregular due to the presence of kinks in the projection of the neck and body, dimensions 63*25*25 mm. The walls are not thickened, uniform in density, single-layer. The hepatic choledochus is 3.4 mm (the norm is 6 mm), it is not traceable throughout its entire length, it is passable, the contents are heterogeneous, the walls are moderately compacted. The contours are smooth and clear. The cavity is heterogeneous due to hypoechoic fine suspension. The initial volume of the gallbladder is 18.81 cubic cm. After giving a trial breakfast at 30 minutes, the gallbladder decreased by 51%.
According to ultrasound and clinical data, it was possible to conclude that the patient has a congenital deformation of the gallbladder in the neck and body with signs of bile stagnation - dyskinesia of the hypotonic type ("flaccid" gallbladder) with the presence of hypoechoic fine bile (sludge).
Treatment of bitterness in the mouth in the morning: preventive measures
If bitterness in the mouth is episodic, you should pay attention first of all to your diet. It is necessary to limit the consumption of fatty and smoked foods, coffee, strong tea, processed foods and sweets. Focus on cereals, fresh vegetables and dairy products. You should eat small meals, but often. Normalize your drinking regime. Stop smoking and alcohol. If the cause of bitterness is stressful situations, make an appointment with a psychotherapist. Our doctors will also help solve the problem. If you are concerned about the question “why does a bitter taste appear in your mouth after eating,” make an appointment right now.
Related services: Family doctor consultation Videogastroduodenoscopy
Force Majeure. The effect of antibiotics on the biliary system
The study was not carried out in April, because The patient had an attack of acute appendicitis, surgery, then a two-week course of antibiotics.
After 2 months, pain in the right hypochondrium, belching, bitterness in the mouth, and intestinal discomfort began again. And only in September the patient decided to do an ultrasound of the gallbladder and consult a gastroenterologist.
On ultrasound, the cavity of the gallbladder is heterogeneous due to the presence of hypoechoic fine suspension and putty-like bile, occupying about 2/3 of the lumen of the gallbladder. The maximum contraction of the gallbladder was 25.1%.
The patient shows pronounced negative dynamics in the gallbladder, most likely associated with the course of antibiotics: the contractile function of the gallbladder has significantly worsened, the quality of bile has changed, and sludge has formed, occupying 2/3 of the lumen of the gallbladder.
Causes
Bitterness in the mouth after antibiotics is a nonspecific symptom. It may appear with other provoking factors and diseases of the digestive tract. But there are some features that can be used to link the appearance of bitterness in the mouth with the effect of an antibacterial drug:
- A bitter taste appears after using the tablet, including after several hours.
- If the drug does not have an enteric coating, a bitter taste in the mouth appears immediately, since the tablet begins to dissolve upon contact with saliva.
- Associated symptoms often occur: pain in the right hypochondrium, yellow discoloration of the skin and/or mucous membranes, diarrhea, high body temperature, the color of urine becomes similar to dark beer.
If the clinical picture of chronic cholecystitis develops and bitterness occurs with even a slight manifestation of accompanying symptoms, it is necessary to stop taking the medication and immediately contact the attending physician who prescribed it.
If there is severe bitterness in the mouth, which appears after starting treatment with antibacterial drugs and lasts for more than a few hours, you need to consult a specialist. It is possible that there was an exacerbation of the existing chronic pathology of the gastrointestinal tract.
The appearance of bitterness in the mouth can be associated with the following diseases:
| Cause | Mechanism of symptom occurrence |
| Gastroesophageal reflux/Gastroesophageal reflux disease | Under the influence of drugs, the symptoms of the pathology, including an unpleasant aftertaste, intensify. Antibiotics are not usually used to treat reflux disease, but if it is associated with gastritis caused by H. pylori, they may be prescribed |
| Exacerbation of cholelithiasis | The formation of stones in the biliary tract or gallbladder disrupts the flow of bile. The pathology manifests itself as pain in the right hypochondrium after eating fatty or spicy foods, jaundice, nausea and vomiting. If the patient already has the disease, then under the influence of antibacterial agents it worsens |
| Liver diseases | Hepatotoxic antibiotics have a damaging effect on the organ, aggravating the course of the disease. Pain and heaviness appear in the liver, jaundice, digestive disorders |
| Dysbacteriosis | This is a condition that often develops after taking antibiotics. Together with pathogenic microorganisms, the drug also destroys beneficial bacteria that live in the human intestines and participate in the digestion process. Symptoms of this pathology are a bitter taste in the mouth and loose stools. |
| Allergy | Individual intolerance to the components of the drug can also cause bitterness in the mouth |
An unpleasant taste often occurs during the treatment of gastritis. This is a stomach disease, most often caused by the bacterium H. pylori and manifested by stomach pain - when hungry or after eating, nausea, vomiting. To eradicate (destruct) Helicobacter, antibacterial drugs are used, sometimes 2-3 antibiotics, the side effects of which include bitterness in the mouth.
Antibiotic agents that most often lead to bitterness in the mouth are clarithromycin, Klacid, chloramphenicol, ampicillin, amoxicillin, ciprofloxacin, ticarcillin, tetracycline.
Correction of treatment
Treatment was prescribed for a longer period of 3-4 months, humane tubes, ursodeoxycholic acid preparations, choleretic drugs, a diet, and therapeutic nutrition were prescribed.
Patients who already have gallbladder dyskinesia and bile sludge should protect the liver and biliary tract during antibiotic treatment and continue individual treatment based on the duration of treatment and the set of drugs after the end of the course.
The drugs Heptral, Ursosan and its analogues, Hofitol and other choleretic drugs have proven themselves well. If, after taking antibiotics, complaints of pain in the right hypochondrium or bitterness in the mouth appear, it is necessary to conduct an examination of the biliary system and carry out the required amount of treatment.
Causes of bitterness in the mouth
Bitterness in the mouth can be a symptom of various diseases.
Most often it is caused by diseases of the organs responsible for the production and movement of bile in the body, such as chronic cholecystitis
(inflammation of the gallbladder),
cholelithiasis
(in this case, the formation of stones interferes with the proper outflow of bile),
biliary dyskinesia
(impaired motility). Sometimes patients who previously had a bitter taste in the mouth due to cholelithiasis or inflammation of the gallbladder, and who had a cholecystectomy (surgery to remove the gallbladder), are surprised by the return of the symptom. But a bitter taste in the mouth can occur even in the absence of a gallbladder, because bile is still produced and can enter the stomach, and from it into the esophagus. If a person has had their gallbladder removed but has not changed their eating habits, the return of digestive problems and a bitter taste in the mouth is very likely
Bitterness in the mouth can occur with various disorders of the digestive system, for example with chronic gastritis
or
chronic pancreatitis
Liver diseases can lead to changes in the composition of saliva, which may also result in a bitter taste in the mouth.
Another group of reasons for the feeling of bitterness in the mouth is diseases of the oral cavity (stomatitis, inflammation of the tongue). A bitter taste can also be a reaction to dentures if they were chosen incorrectly (the individual intolerance of the material from which they are made was not taken into account).
Sometimes bitterness in the mouth is caused by other reasons: toxicosis (in pregnant women), acute poisoning, cancer.
The functioning of the digestive system, symptoms and consequences of bladder removal
Normally, bile is secreted and flows through the ducts into the duodenum after the action of an irritant, which can be food intake. The rate of secretion depends on the type and quantity of food consumed. When the gallbladder is removed, the ducts ensure continuous delivery of secretions to the intestines, independent of the action of the irritant. A constant supply of the enzyme can cause a number of consequences, among which are symptoms and conditions such as:
- The accumulation of large volumes of digestive juices and their stagnation, causing irritation of the intestinal mucosa.
- Violation of the process of absorption of nutrients.
- Nausea, belching and vomiting in case of reflux of secreted secretions.
- Possibility of damage to the intestinal walls with the release of bile into the abdominal cavity.
- Disturbance of the intestinal microflora, leading to flatulence.
- The appearance of liver or intestinal colic.
- There is a danger of penetration of pigments that make up bile into the bloodstream, which can result in general intoxication of the body.
- Disruption of metabolism and metabolic processes that regulate the supply of necessary substances and fats, associated with damage to muscle tissue in the area surrounding the channels for the passage of bile into the duodenum.
- The development of inflammatory processes and dysbacteriosis associated with disruption of metabolic processes.
- Stagnation of bile, formation of stones and an increase in the likelihood of secondary development of cholelithiasis, the elimination of which in most cases is possible only with the help of surgery.
Depending on the individual characteristics of the disease, the onset of one or more of the listed conditions, called post-chocystectomy syndrome by specialists, is possible.
Surgery and the stress that follows is a normal reaction of the body to a surgical procedure. During the time required to restore the body's functioning, the patient may feel weakness, increased formation of gases, a bitter taste in the mouth and other symptoms.
