Colloidal bismuth in the treatment of duodenal ulceration: the benefit for the patient.

Colloidal bismuth subcitrate (CBS) heals gastric and duodenal ulcers better than placebo and at rates similar to those observed with the commonly used H2-antagonists. Indeed, healing of duodenal ulcers may be more rapid than with cimetidine during the first month of treatment. When treatment is withdrawn, however, relapse is slower after CBS than after the H2-antagonists. The mechanism is uncertain but may be related to the ability of CBS to suppress Campylobacter pylori infection. The clinical implications of this difference in relapse rates are discussed. Preliminary data suggest that duodenal ulcer patients who are rendered C. pylori-negative for a prolonged period may be relatively immune to relapse. If confirmed, and if a suitably effective regimen can be found, this will transform the management of this difficult clinical problem.