title: Mechanism of action of Roter (bismuth subnitrate) in patients with duodenal ulcer disease and healthy volunteers.
abstract: The effects of Roter (compound bismuth subnitrate) on antacid activity and mucosal prostaglandin E2 (PGE2) synthesis were variously investigated in patients with duodenal ulcer disease and healthy volunteers. Roter had a significant but small antacid activity with a buffering capacity of 10.9 mmol per tablet. In healthy volunteers, this was assessed by 24 h gastric pH monitoring on matched days with and without Roter treatment. The percentage of time that gastric pH was above 3 and the time after a standard meal that the pH was above 3, were both significantly increased by treatment with Roter (II tds post-cibal) (P less than 0.01). Endogenous PGE2 synthesis was measured in endoscopic duodenal biopsies taken both before and after Roter treatment in patients with acute untreated duodenal ulceration. There was a significant deficiency of mucosal PGE2 synthesis in untreated patients compared with controls (P less than 0.005). However, following 4 weeks' treatment with Roter, there was a 90% rate of healing accompanied by a significant increase in PGE2 synthesis (P less than 0.05) up to control levels. These findings suggest that Roter heals by the combined effects of a modest antacid neutralizing capacity and the ability to restore mucosal prostaglandins to normal levels, thereby mediating prostaglandin-dependent defence mechanisms.
authors: Department of Surgery and Gastroenterology, Faculty of Clinical Sciences, University College, London, United Kingdom.
authors: S
authors: S
authors: Pugh
authors: M R
authors: MR
authors: Lewin
mesh_terms: D000328:Adult; D000863:Antacids / Q000494:pharmacology / Q000627:therapeutic use*; D001729:Bismuth / Q000494:pharmacology / Q000627:therapeutic use*; D015232:Dinoprostone / Q000096:biosynthesis; D004341:Drug Evaluation; D004381:Duodenal Ulcer / Q000188:drug therapy*; D005260:Female; D005744:Gastric Acid / Q000378:metabolism; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007413:Intestinal Mucosa / Q000378:metabolism; D008297:Male; D008875:Middle Aged
chemical_list: D000863:Antacids; C010804:bismuth subnitrate; D015232:Dinoprostone; D001729:Bismuth