Treatment of ulcerative reflux oesophagitis with colloidal bismuth subcitrate in combination with cimetidine.

Abstract

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.

Inverse background of Helicobacter pylori antibody and pepsinogen in reflux oesophagitis compared with gastric cancer: analysis of 5732 Japanese subjects

“…The pathogenic role of H pylori in reflux oesophagitis was suspected in earlier studies37 38 while most other studies found no relationship 5-11. In contrast, the possible protective role of H pylori in reflux oesophagitis and other GORD related diseases such as Barrett's oesophagus and oesophageal adenocarcinoma has recently been suggested 12-14…”

Different management for Helicobacter pylori positive and negative patients with gastro-oesophageal reflux disease?

“…In the latter group, healing of oesophagitis was significantly better. 57 At entry evidence of H pylori was present in nine patients-in the five patients treated with combination therapy cultures were negative within one week, while they were negative in two of four patients treated with cimetidine alone. Although these findings do suggest a benefit for eradication therapy at least in patients with severe oesophagitis, patient numbers were small, and the eYcacy of diagnostic tests for H pylori is limited during continued acid suppression.…”

“…[56][57][58][59][60][61][62][63][64][65][66][67] Although all of the studies did not have adequate numbers of patients or control populations, the overall prevalence of H pylori is not significantly greater in patients with GORD than what would be expected in the general population (table 1). H pylori had been diagnosed by various methods in just 35% of almost 700 patients with varying degrees of reflux disease (table 1).…”

“…In one of the earlier studies which enrolled patients with either grade 3 or 4 oesophagitis only, evidence of H pylori was reported in 45%. 57 Since then, there have been a number of studies which have failed to detect H pylori in the squamous oesophageal mucosa of patients with reflux disease. 58-61 65 67 In one of the larger series of patients where the prevalence of H pylori was 54% in the stomach, evidence of the organism was found in a hiatus hernia in 44% of 64 patients.…”

Bismuth

“…Soluble salts such as bismuth subsalicylate, sodium triglycollamate and trioglycolate have been used parenterally to treat infectious diseases (notably syphilis). Bismuth salicylate, subcarbonate, subcitrate, subnitrate, glycobiasol and other salts are used orally, or have been reported for use in the treatment of reflux esophagitis (Borkent and Beker 1988), gastritis (McNulty et al 1986), indigestion (Hailey and Newsom 1984), diarrhea, and other gastrointestinal disorders. In particular, colloidal bismuth subcitrate (CBS), when given in combination with antibiotics, is very effective at concentrations of 10 -16 mg Bi L À1 against mucosal Campylobacter pylori.…”