Senderovich Helen, Vierhout Megan
Geriatrics & Pain Medicine & Palliative Care Physician, Baycrest Health Sciences, Toronto, Ontario, Canada.
Assistant Professor at the Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Ontario, Canada.
Rambam Maimonides Med J. 2021 Jan 19;12(1):e0002. doi: 10.5041/RMMJ.10422.
Diarrhea, an illness of both the developed and developing world, involves the burdensome characteristics of frequent bowel movements, loose stools, and abdominal discomfort. Diarrhea is a long-standing challenge in palliative care and can have a myriad of causes, making symptomatic treatment pertinent when illness evaluation is ongoing, when there is no definitive treatment approach, or when effective treatment cannot be attained. Symptomatic therapy is a common approach in palliative care settings. Bismuth is a suitable agent for symptomatic therapy and can be effectively employed for management of chronic diarrhea. The objective of this narrative review is to examine the role of bismuth in management of diarrheal symptoms. To explore this, PubMed (including Medline) and Embase were used to search the existing literature on bismuth and diarrhea published from 1980 to 2019. It was found that bismuth has potential utility for diarrheal relief in multiple settings, including microscopic colitis, traveler's diarrhea, gastrointestinal infection, cancer, and chemotherapy. It also has great potential for use in palliative care patients, due to its minimal side effects. Overall, the antisecretory, anti-inflammatory, and antibacterial properties of bismuth make it a suitable therapy for symptomatic treatment of diarrhea. The limited range of adverse side effects makes it an appealing option for patients with numerous comorbidities. Healthcare providers can explore bismuth as an adjunct therapy for diarrhea management in an array of conditions, especially in the palliative care setting.
腹泻是一种在发达国家和发展中国家都存在的疾病，其特征包括排便频繁、大便稀溏以及腹部不适等令人困扰的症状。腹泻在姑息治疗中一直是个难题，病因众多，因此在疾病评估仍在进行、尚无明确治疗方法或无法实现有效治疗时，对症治疗就显得尤为重要。对症治疗是姑息治疗环境中的常用方法。铋是对症治疗的合适药物，可有效用于慢性腹泻的管理。本叙述性综述的目的是探讨铋在腹泻症状管理中的作用。为了探究这一点，我们使用PubMed（包括Medline）和Embase检索了1980年至2019年发表的关于铋与腹泻的现有文献。研究发现，铋在多种情况下对缓解腹泻具有潜在作用，包括显微镜下结肠炎、旅行者腹泻、胃肠道感染、癌症和化疗。由于其副作用极小，铋在姑息治疗患者中也具有很大的应用潜力。总体而言，铋的抗分泌、抗炎和抗菌特性使其成为腹泻对症治疗的合适药物。有限的不良反应范围使其成为患有多种合并症患者的一个有吸引力的选择。医疗服务提供者可以探索将铋作为一系列病症腹泻管理的辅助治疗方法，尤其是在姑息治疗环境中。
