SUMMARY Twenty patients took part in a controlled double blind study comparing the efficacy of colloidal bismuth and cimetidine (800 mg at night) with cimetidine alone in the treatment of ulcerative reflux oesophagitis. Colloidal bismuth 120 mg was administered through an intraoesophageal tube four times a day. Cimetidine with colloidal bismuth gives significantly (p<0001) better results than cimetidine alone. Of 10 patients treated with cimetidine and bismuth, seven had no endoscopic signs of oesophagitis after three weeks and three had grade I oesophagitis. Of 10 patients treated with cimetidine alone, one had grade I oesophagitis and three grade II oesophagitis after three weeks. The remaining six still had grade III oesophagitis. This study also shows that in nine of 10 patients reflux oesophagitis was accompanied by infection with campylobacter like organisms (CLO). After treatment the bacteria disappeared promptly in five patients receiving combination therapy and in two of four treated with cimetidine alone. The possible role of CLO in reflux oesophagitis is uncertain.Gastro-oesophageal reflux is a quite common condition, usually accompanied by incompetence of the lower oesophageal sphincter.' Oesophagitis develops in only about one half of patients with gastrooesophageal reflux.4Reflux oesophagitis is usually treated with H2-receptor antagonists, antacids in gel or drugs that promote gastric emptying together with postural and dietary recommendations.' In some cases, however, the reflux oesophagitis does not respond to conventional therapy and admission to hospital is necessary. Persistent reflux oesophagitis remains a therapeutical challenge.Colloidal bismuth subcitrate has been proved to be effective in peptic ulcer disease. It is known as a cytoprotective agent that stimulates the generation of mucosal prostaglandin E2 and retards the movement of hydrogen ions.f Because of these properties colloidal bismuth was thought to be a useful therapeutic agent for ulcerative reflux oesophagitis. During the past three years 36 patients have been successfully treated with colloidal bismuth adminis- The aim of the present study was to compare colloidal bismuth in combination with cimetidine and cimetidine alone for the treatment of reflux oesophagitis. Furthermore the proportion of patients with reflux oesophagitis and CLO was determined. Methods PATI ENTSTwenty patients (eight men, 12 women; mean age 69-1 years, (56-79)) with endoscopically and histologically proven grade I1-1Va reflux oesophagitis'4 (Table) were admitted to the trial. All patients had 385 on 11 May 2018 by guest. Protected by copyright.
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