Gorbach S L
Department of Community Health, Tufts University School of Medicine, Boston, Massachusetts.
Gastroenterology. 1990 Sep;99(3):863-75. doi: 10.1016/0016-5085(90)90983-8.
Bismuth therapy has shown efficacy against two major gastrointestinal disorders: peptic ulcer disease and diarrhea. In peptic ulcer disease it is as effective as the H2-receptor antagonists, costs considerably less, and offers a lower rate of relapse. When Helicobacter pylori is implicated, bismuth acts as an antimicrobial agent, suppressing the organism but not eliminating it. In recent studies, bismuth compounds have been used with conventional antibiotics, producing elimination of the organism, histological improvement, and amelioration of symptoms for periods longer than one year. Bismuth subsalicylate has shown modest efficacy in treating traveler's diarrhea and acute and chronic diarrhea in children, and it is effective prophylactically for traveler's diarrhea. An epidemic of neurological toxicity was reported in France in the 1970's with prolonged bismuth treatment, usually bismuth subgallate and subnitrate. Such toxicity has been rare with bismuth subsalicylate and colloidal bismuth subcitrate. However, recent studies have demonstrated intestinal absorption of bismuth (about 0.2% of the ingested dose) and sequestration of this heavy metal in multiple tissue sites, even occurring with conventional dosing over a 6-week period. These findings have inspired recommendations that treatment periods with any bismuth-containing compound should last no longer than 6-8 weeks, followed by 8-week bismuth-free intervals.
消化性溃疡病和腹泻。在消化性溃疡病中，它与H2受体拮抗剂一样有效，成本低得多，且复发率较低。当涉及幽门螺杆菌时，铋剂作为一种抗菌剂，可抑制该菌但不能将其根除。在最近的研究中，铋化合物与传统抗生素联合使用，可根除该菌、改善组织学状况并使症状缓解长达一年以上。碱式水杨酸铋在治疗旅行者腹泻以及儿童急慢性腹泻方面已显示出一定疗效，并且对旅行者腹泻有预防作用。20世纪70年代法国报告了一起因长期使用铋剂治疗（通常是碱式没食子酸铋和次硝酸铋）导致的神经毒性流行事件。碱式水杨酸铋和枸橼酸铋钾很少出现这种毒性。然而，最近的研究表明铋可被肠道吸收（约占摄入剂量的0.2%），并且这种重金属会在多个组织部位蓄积，即使在常规剂量连续服用6周的情况下也会发生。这些发现促使人们建议，任何含铋化合物的治疗期不应超过6 - 8周，随后应间隔8周不使用铋剂。
