Campylobacter associated gastritis in patients with non-ulcer dyspepsia: a double blind placebo controlled trial with colloidal bismuth subcitrate.

Abstract

SUMMARY Fifty consecutive patients with non-ulcer dyspepsia and a Campylobacter associated gastritis (CAG) were randomly assigned to treatment with colloidal bismuth subcitrate (CBS) 240 mg twice daily or placebo, according to a double blind study design. After the blind treatment an 'open' treatment with CBS was started in both groups. Twenty six patients treated with CBS showed a significant reduction in colonisation with Campylobacter pyloni and a significant improvement in the Whitehead gastritis score. No significant changes were recorded in twenty four patients treated with placebo. After an additional course of CBS no further improvement in gastritis score was noted but there was a further reduction in Campylobacter colonisation. CBS did not greatly alter subjective complaints. Subjective complaints were improved in both treatment groups except for nausea and meteorism that improved more in the CBS treated patients. This finding again questions the clinical significance of gastritis and also casts doubt on the clinical relevance of therapeutical measures aimed at eradication of C pylon.Reports on the presence of spiral bacteria in the human stomach have appeared sporadically over the last century.' Since the work of Marshall and Warren, however, the possible pathogenetic significance of these organisms on type B (antral) gastritis was appreciated,4 and was confirmed by other investigators.5`Campylobacter pylori is found in 98% of patients with gastritis, in 80% of patients with gastric ulcer and in 90% of patients with duodenal ulcers. In patients with dyspeptic symptoms but normal gastric histology C pylori has also been seen overlying the mucosa but only in small numbers.' About one third of patients referred for upper gastrointestinal endoscopy because of upper abdominal complaints appear not to suffer from peptic ulcers, oesophagitis, active duodenitis, or gastric carcinoma and therefore by definition suffer from socalled non-ulcer dyspepsia. These patients constitute a heterogenous

Local gastric and serum amoxicillin concentrations after different oral application forms

“…Superior results were reported after treatment with a combination of two or more antibiotic drugs, especially after triple therapy including, e.g., metronidazole, amoxicillin, and bismuth subcitrate (3). Except for treatment of duodenal ulcer disease that had been resistant to conventional therapy, the risks of possible toxicity, side effects, and development of bacterial drug resistance do not justify the widespread use of antibiotic combinations for relatively harmless conditions such as antral gastritis, especially since there controversy about the clinical relevance of gastritis in nonulcer dyspepsia remains (10,14,17,26).…”

The management of dyspepsia: a systematic review.

“…[186][187][188][189][190][191][192] All reported global dyspepsia symptom scores. The majority of the trials evaluating bismuth assessed the role of H. pylori eradication in NUD.…”

“…Two trials included both H. pylori-positive and -negative individuals and these groups were entered separately to evaluate any difference in outcome according to infection status. 191,192 Six trials reported global dyspepsia improvement as a dichotomous outcome [187][188][189][190]192 and there was a trend towards bismuth salts being more effective than placebo, although this was of marginal statistical significance (RR reduction, 40%; 95% CI, -3 to 65) (Figure 10). Again, significant heterogeneity was noted in the analysis (Q = 18.31; df = 5; p = 0.003), due to the inclusion of one trial 190 with a very low placebo response rate (5%) and a correspondingly large treatment effect (RR reduction, 79%).…”

Antral <i>Helicobacter pylori-</i>Like Organisms in Different States of Gastric Acid Secretion

“…density in antral biopsies though gastritis did not resolve completely in the patients stud ied here except 1. Whether persistence of other factors perpetuating gastritis as sug gested recently [35] or minute amounts of H.p. undetected by histology prevent com plete healing of gastritis is unclear.…”