Antibacterial Treatment of Gastric Ulcers

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Abstract
Sung et al. (Jan. 19 issue)1 reported that in patients with Helicobacter pylori infection and gastric ulcers unrelated to the use of nonsteroidal antiinflammatory drugs, “one week of antibacterial therapy without acid suppression heals the ulcers as well as omeprazole and reduces the rate of their recurrence.” The authors imply that they have proved that therapy directed against H. pylori, and not against ulcers, cures ulcers. There are a number of ways to accelerate ulcer healing without using antisecretory drugs (such as sucralfate or bismuth subcitrate). In our view, Sung et al. actually showed that two regimens that had previously been shown to accelerate ulcer healing were approximately equally effective. Their description of bismuth subcitrate as an antibacterial agent is very misleading, because it is an extremely effective antiulcer agent independently of its antimicrobial activity. Colloidal bismuth subcitrate is an effective antiulcer agent whose effectiveness is not limited to ulcers associated with H. pylori. 2,3 Other bismuth preparations do not appear to have similar behavior with respect to experimental ulcers. For example, histochemical staining has been used to compare the ability of bismuth subnitrate, bismuth subcarbonate, bismuth subsalicylate, and colloidal bismuth subcitrate to coat experimental gastric ulcers in rats.3 When colloidal bismuth subcitrate was administered, bismuth was deposited in a uniform layer covering the ulcer base. The histochemical staining of the ulcer base was negative with the other bismuth salts and remained negative even when the concentrations of bismuth subcarbonate or bismuth subnitrate were increased by a factor of 5. Subsequent studies have demonstrated important differences between different formulations of bismuth subcitrate; colloidal bismuth subcitrate is effective in preventing ulceration in Shay rats, whereas noncolloidal bismuth subcitrate is not.4

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