Review article: bismuth‐based therapy for Helicobacter pylori eradication in children

Abstract

Background: Because of the decrease in the Helicobacter pylori eradication rate after standard triple therapy with a proton pump inhibitor and two antibiotics, bismuth-based therapy has recently been recommended as alternate firstline regimen in children. Aim: To comprehensively review the clinical, pharmacologic and microbiologic properties of bismuth salts, and to summarise the evidence for the therapeutic efficacy of bismuth-based therapy for H. pylori eradication in children. Methods: Bibliographical searches were performed in MEDLINE. Results on the efficacy of bismuth-containing regimens on H. pylori eradication were combined using the inverse variance method. Results: Bismuth monotherapy showed a very low efficacy. Overall, the mean eradication rate with bismuth-based dual therapy was 68% (95% CI, 60-76%) (intention- to-treat analysis-ITT) and 73% (95% CI, 64-81%) (per protocol-PP). In case series, the overall percentages of children with successful eradication for triple therapy containing bismuth were 82% (95% CI, 76-88%) and 86% (95% CI, 80-92%) according to ITT and PP respectively. In comparative studies, H. pylori eradication rates ranged between 69% and 85% according to ITT and between 74% and 96% PP. Side effects included dark stools, urine discoloration, black tongue, burning tongue, and marked darkness of the gums. Conclusions: The evidence in favour of bismuth compounds for treating infected children is still not clear. Well-designed, randomised, multi-centre studies of H. pylori eradication trials in children comparing bismuth-based triple therapy with the best available recommended first-line therapies are needed. The evidence obtained from audited case series that produce an eradication rate of >95% on PP analysis should also be considered. © 2012 Blackwell Publishing Ltd

Assessment of Efficacy and Adverse Effects of Bismuth-Based Treatment Combined with Bifidobacterium Lactis for Eradication of Helicobacter Pylori in Turkish Children

“…Bismuth-based quadruple eradication regimen is highly effective in H. pylori infection but has the disadvantages of risking poor compliance and causing side effects. 36 In contrast to other studies, we did not observe any treatment abandonment. We observed high eradication rates in both groups and decreased complaints of abdominal pain and distention in the B. lactis group on days 7 and 14.…”

Ureases: Historical aspects, catalytic, and non-catalytic properties – A review

“…Bismuth (Bi 3+ ) was shown to inactivate HPU by interacting with the cysteine residue of the mobile flap [103] . Due to the bactericidal activity, bismuth compounds have been widely used to treat gastric ulcers associated to H. pylori infection [104] , [105] .…”

Helicobacter pylori antibiotic resistance profile in Chinese children with upper gastrointestinal symptoms and a literature review for developing personalized eradicating strategies

“…Combination therapy does not have a superior eradication rate and, therefore, is not recommended when other treatment regimens are available. Bismuth compounds may play two main roles: heavy metals possess antimicrobial properties and interfere with H. pylori attachment when these electron-dense bodies are deposited on the cell surface ( Pacifico et al, 2012 ), and bismuth compounds have a synergistic effect with antibiotics in overcoming multi-antibiotic resistance ( Ko et al, 2019 ).…”

“…Eradication rates in areas with high CLA resistance are lower than those in areas with low CLA resistance (Liang et al, 2012). In a study performed in Wenzhou, Zhejiang province, China, when CLA resistance reached 26.12%, the efficacies of triple therapy and bismuth-containing quadruple therapy based on the antibiotic susceptibility test were 67.32% and 68.49%, respectively (Pan et al, 2020). Studies in Vietnam revealed increased resistance to CLA, with rates of 50.9% in 2006 (Le et al, 2022), 84.6% in 2012 (Le et al, 2022), 92.1% in (Van Thieu et al, 2021, and 81% in 2022 (Borka et al, 2023).…”