Bismuth compounds have been used for centuries in medicine. The discovery of H. pylori in 1983 led to renewed interest in bismuth compounds, because these were found to successfully treat the infection in combination with antibiotics. However, in the 1970s bismuth salts, used at high doses for prolonged periods, were found to lead to neurotoxicity. There has been no summary of evidence for the toxicity of bismuth when used for short periods as part of H. pylori eradication therapy.
A research article to be published on December 28, 2008 in the World Journal of Gastroenterology addresses this question. The research team led by Professor Paul Moayyedi from McMaster University, Canada performed a systematic review and meta-analysis to assess the safety of bismuth compounds, when used in a 1 or 2-week course of H. pylori eradication therapy. They examined the risk of adverse events in randomized controlled trials using bismuth compounds as part of H. pylori eradication therapy compared to other regimens.
Thirty-five randomized controlled trials containing over 4500 patients were identified comparing bismuth with placebo or no treatment, or bismuth salts in combination with antibiotics as part of eradication therapy with the same dose and duration of antibiotics alone or in combination with acid suppression. There were no differences in the total number of adverse events with bismuth versus comparison regimen. Individual adverse events were also no more frequent with bismuth, with the exception of dark stools. There were no significant differences detected in the number of adverse events leading to withdrawal of therapy with bismuth versus comparison regimen.
Their results indicated that Bismuth compounds, when used as part of H. pylori eradication therapy, are safe and well-tolerated. The only adverse event occurring more frequently with bismuth compounds was dark stools, which is of little clinical significance.
These results are encouraging, because there have been recent concerns expressed that PPI-based triple therapies for H. pylori do not lead to satisfactory eradication rates, and therefore the use of bismuth containing regimens has been recommended as a potential first line therapy in the recent Maastricht guidelines. Furthermore, there are now new bismuth combinations commercially available. For these reasons it is important to be sure of the safety of bismuth compounds.
Reference: Ford AC, Malfertheiner P, Giguère M, Santana J, Khan M, oayyedi P. Adverse events with bismuth salts for Helicobacter pylori eradication: Systematic review and meta-analysis. World Gastroenterol 2008; 14(48): 7361-7370
Correspondence to: Dr. Alexander C Ford, Gastroenterology Division, McMaster University Medical Centre, 1200 Main Street West, Hamilton, Ontario L8N 3Z5, Canada. firstname.lastname@example.org
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World Journal of Gastroenterology (WJG), a leading international journal in gastroenterology and hepatology, has established a reputation for publishing first class research on esophageal cancer, gastric cancer, liver cancer, viral hepatitis, colorectal cancer, and H. pylori infection and provides a forum for both clinicians and scientists. WJG has been indexed and abstracted in Current Contents/Clinical Medicine, Science Citation Index Expanded (also known as SciSearch) and Journal Citation Reports/Science Edition, Index Medicus, MEDLINE and PubMed, Chemical Abstracts, EMBASE/Excerpta Medica, Abstracts Journals, Nature Clinical Practice Gastroenterology and Hepatology, CAB Abstracts and Global Health. ISI JCR 2003-2000 IF: 3.318, 2.532, 1.445 and 0.993. WJG is a weekly journal published by WJG Press. The publication dates are the 7th, 14th, 21st, and 28th day of every month. WJG is supported by The National Natural Science Foundation of China, No. 30224801 and No. 30424812, and was founded with the name of China National Journal of New Gastroenterology on October 1, 1995, and renamed WJG on January 25, 1998.
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