Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
Helicobacter. 2021 Jun;26(3):e12801. doi: 10.1111/hel.12801. Epub 2021 Mar 19.
Bismuth oxychloride produced by interaction of bismuth compounds with gastric acid is believed to damage Helicobacter pylori. The effect of bismuth salts on H. pylori in the presence of strong acid suppression is unknown. This randomized trial aimed to determine effects of bismuth subcitrate on H. pylori with and without acid suppression.
H. pylori -positive participants were allocated (1:1:1) to receive (a) no treatment (control), (b) colloidal bismuth subcitrate (CBS, 125 mg/tab), or (c) CBS plus high-dose proton-pump inhibitor (PPI), esomeprazole 40 mg q.i.d. for 3 days. In the treatment groups, CBS was given: 1 dose, 1 hour before endoscopy, 1 dose, 4 hours before endoscopy, or q.i.d. 24 hours before endoscopy. The study end-points were evaluated using transmission electron microscopy to observe the morphological changes of H. pylori in antral and corpus biopsies.
Twenty-seven H. pylori carriers were enrolled in this trial with qualitative end-points. In the no treatment group, active budding and replication of H. pylori were observed. In the CBS group, cellular swelling, vacuolization, structural degradation, and cell wall eruption of H. pylori were observed, with no apparent association with when the CBS was given. Among those receiving high-dose PPI-plus CBS or CBS only, there were no differences in number of H. pylori present or severity of bacterial damage whether CBS was given 1, 4, or 24 hours before endoscopy.
Based on direct morphological evaluation, the toxic effect of CBS treatment on H. pylori was demonstrated independent of acid suppression with PPI.
人们认为，由铋化合物与胃酸相互作用产生的碱式氯化铋会损伤幽门螺杆菌。在强力酸抑制的情况下，铋盐对幽门螺杆菌的影响尚不清楚。这项随机试验旨在确定枸橼酸铋钾在有或无酸抑制的情况下对幽门螺杆菌的作用。
将幽门螺杆菌阳性的参与者（1:1:1）随机分配接受（a）无治疗（对照组）、（b）胶体枸橼酸铋钾（CBS，125mg/片）或（c）CBS 加高剂量质子泵抑制剂（PPI），埃索美拉唑 40mg，每日 4 次，共 3 天。在治疗组中，CBS 的给予方式为：1 剂，内镜检查前 1 小时，1 剂，内镜检查前 4 小时，或每日 4 次，内镜检查前 24 小时。使用透射电子显微镜观察胃窦和胃体活检中幽门螺杆菌的形态变化来评估研究终点。
这项试验纳入了 27 名幽门螺杆菌携带者，进行了定性终点评估。在无治疗组中，观察到幽门螺杆菌的活跃出芽和复制。在 CBS 组中，观察到幽门螺杆菌的细胞肿胀、空泡化、结构降解和细胞壁破裂，但与 CBS 的给予时间无明显关联。在接受高剂量 PPI 加 CBS 或仅 CBS 的患者中，无论 CBS 在内镜检查前 1、4 或 24 小时给予，幽门螺杆菌的数量或细菌损伤的严重程度均无差异。
基于直接形态学评估，在 PPI 抑制酸的情况下，CBS 治疗对幽门螺杆菌的毒性作用得到了证实。
