Bismuth subsalicylate in the treatment of gastritis due to Campylobacter pylori.

Fifty patients completed an investigator-blind trial comparing bismuth subsalicylate, erythromycin ethylsuccinate, and placebo matched to the bismuth salt in the treatment of gastritis associated with Campylobacter pylori. C. pylori was cleared from 14 (77.8%) of 18 patients given locally active bismuth, from one (6.7%) of 15 patients given erythromycin, and from none of 17 patients given placebo. Gastritis resolved in 13 (81%) of 16 patients treated with bismuth but in only three of 13 receiving erythromycin and in none of 16 patients given placebo. Results of endoscopic examination showed greater improvement in patients cleared of C. pylori than in those with persistent infection. Heartburn improved in 50% of patients who received bismuth compared with 17% of those given placebo. The success of bismuth is probably due to its local antimicrobial activity. Erythromycin may have been inactivated by the low pH in the areas colonized with C. pylori. Relapse is less frequent when a combination of bismuth and an antimicrobial agent is used; such a combination is characterized by local and systemic activity, stability at low pH, and good penetration into gastric mucus.