Bismuth salts with versus without acid suppression for Helicobacter pylori infection: A transmission electron microscope study. Issue 3 (19th March 2021)

• Record Type: Journal Article
• Authors: Chiang, Tsung‐Hsien; Chen, Chieh‐Chang; Tseng, Ping‐Huei; Liou, Jyh‐Ming; Wu, Ming‐Shiang; Shun, Chia‐Tung; Lee, Yi‐Chia; Graham, David Y.
• Is Part Of: Helicobacter. Volume 26:Issue 3(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-03-19
• Subjects: bismuth -- Helicobacter pylori -- light microscopy -- transmission electron microscopy -- ultrastructure; Helicobacter -- Periodicals; Helicobacter infections -- Periodicals; Stomach -- Diseases -- Periodicals; 616.3301405
• DOI: 10.1111/hel.12801
• Languages: English
• ISSNs: 1083-4389

Abstract

Abstract: Background: 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. Methods: 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. Results: 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. Conclusions: Based on direct morphological evaluation, the toxic effect of CBS treatment on H . pylori was demonstrated independent of acid suppression with PPI.