The effect of bismuth subsalicylate on the histologic gastritis seen with Campylobacter pylori: a placebo-controlled, randomized study.

In order to assess whether bismuth subsalicylate (BSS) clears Campylobacter pylori and whether this clearance is associated with improvement in histologic gastritis, 20 patients with antral biopsies colonized by C. pylori were randomized to treatment with 30 ml of BSS (525 mg) or placebo q.i.d. for 21 days. After both 2 and 3 wk of treatment, C. pylori was cleared in 70% (7/10) of BSS-treated patients, compared with 10% (1/10) of patients on placebo (p less than 0.05) at 2 wk and 0% (0/10) of patients on placebo at 3 wk (p less than 0.01). A significant improvement in histologic gastritis (p less than 0.05) was noted after 2 and 3 wk of treatment in the group receiving BSS. Gastritis improvement was a result of both reduced polymorphonuclear and mononuclear cell infiltration. Clearance of C. pylori was highly correlated with improvement of histologic gastritis (p less than 0.001). In addition, mucus depletion scores were significantly improved in the BSS-treated group. These data indicate that treatment with BSS provides short-term clearance of C. pylori in antral mucosa, and this clearance is associated with an improvement in histologic gastritis. These findings support the pathogenic role of C. pylori in histologic antral gastritis.