Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Bismuth compounds—most notably bismuth subsalicylate and bismuth subcitrate—have a well-established role in the treatment and support of duodenal ulcers, primarily due to scientific validation. Bismuth’s therapeutic benefit arises from several mechanisms: it coats ulcer bases, creating a protective barrier against acid and pepsin; it stimulates prostaglandin, mucus, and bicarbonate secretion; and, importantly, it has direct antimicrobial activity, particularly against Helicobacter pylori (H. pylori), which is a major causative factor in duodenal ulcer disease. Bismuth compounds are commonly included as a component of “quadruple therapy” for H. pylori eradication, alongside antibiotics and a proton pump inhibitor.

Multiple randomized controlled trials and meta-analyses have demonstrated that bismuth-containing regimens are effective both in eradicating H. pylori and in promoting ulcer healing. For instance, a Cochrane review found that bismuth-based quadruple therapy achieved eradication rates comparable to or exceeding some standard triple therapies, especially in regions with high antibiotic resistance. Additionally, bismuth’s mucosal protective effects can provide symptomatic relief and promote healing, independent of its antibiotic properties.

Historically, bismuth salts were used for gastrointestinal symptoms before the discovery of H. pylori, but modern use is strongly backed by scientific research. Side effects are generally mild and self-limiting. In summary, the use of bismuth in duodenal ulcer management is scientifically justified and supported by high-quality clinical evidence.

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