Relief of dyspeptic symptoms by colloidal bismuth subcitrate in Helicobacter-negative and -positive patients: results of a study in general practice.
BACKGROUND
The role of H. pylori in non-ulcer dyspepsia is controversial. Colloidal bismuth subcitrate (CBS) is known to suppress H. pylori. We hypothesized that if H. pylori is a causal factor in dyspepsia, then suppression of H. pylori would lead to a decrease in symptoms.


OBJECTIVE
To assess the relationship between H. pylori status and the effect of CBS on dyspeptic symptoms in patients visiting their general practitioner for dyspeptic complaints.


METHODS
In total 446 patients between 17 and 81 years of age (median 44 years) were included. All patients were treated with CBS (240 mg Bi2O3) twice a day for 4 weeks. Symptoms were scored at baseline, and after 2 and 4 weeks of treatment. At the first visit, blood was taken for serological H. pylori testing.


RESULTS
During follow up, 65 patients were lost due to violation of protocol. Positive H. pylori serology was found in 110 (24.7%) of the 446 initially selected patients, and in 90 (23.6%) of the 381 patients who completed the protocol (NS). The mean overall symptom score decreased significantly after 4 weeks of CBS (P<0.001). This reduction in overall symptom score was not significantly different between the H. pylori-positive and -negative groups.


CONCLUSIONS
The H. pylori status does not influence the outcome of CBS therapy in patients who consult their general practitioner for dyspepsia. This finding suggests that H. pylori does not play an important role in the etiology of dyspepsia in patients seen by the general practitioner.
Weusten
B L
BL
Department of Internal Medicine, Eemland Hospital, PO Box 1502, 3800 BM, Amersfoort, The Netherlands.
Sicking
P J
PJ
Otten
H W
HW
Smout
A J
AJ
Otten
M H
MH
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000863:Antacids / Q000627:therapeutic use*; D004415:Dyspepsia / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D016481:Helicobacter Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D017060:Patient Satisfaction; D011336:Probability; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000863:Antacids; D009942:Organometallic Compounds; C002791:bismuth tripotassium dicitrate