Campylobacter pylori: its link to gastritis and peptic ulcer disease.

Bismuth salts have been used to treat acid peptic disease for 150 years. Recently, the discovery of Campylobacter pylori and the observation that this bacterium is inhibited by bismuth salts have regenerated interest in the antibacterial properties of bismuth. Bismuth and heavy metals inhibit growth of all Campylobacter species and many enteric anaerobes. Bismuth alone cures C. pylori infection in only 30% of patients, but in combination with other broad-spectrum antibiotics, it can achieve a cure rate of 80%-90% in 2-4 weeks. Data from several studies indicate that eradication of C. pylori is curative for most patients with duodenal ulcer. Epidemiologic studies in the United States suggest that the incidence of new C. pylori infections is declining, so antibacterial therapy for symptomatic cases may be adequate therapy. In developing countries, however, curative therapy may not be possible in the presence of environmental sources of reinfection. In these areas intermittent suppressive therapy with bismuth salts may be useful.