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 hypot hesized that if H. pylori is a causal factor in dyspepsia, then suppression of H. pylori would lead to a decrease in symptoms. Aim: To assess the rela tionship between H. pylori status and the effect of CBS on dyspeptic sympto ms 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) twi ce a day for 4 weeks. Symptoms were scored at baseline, and after 2 and 4 w eeks of treatment. At the first visit, blood was taken for serological H. p ylori testing. Results: During follow up, 65 patients were lost due to viol ation 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 s ignificantly after 4 weeks of CBS (P < 0.001). This reduction in overall sy mptom 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 practition er for dyspepsia. This finding suggests that H. pylori does not play an imp ortant role in the etiology of dyspepsia in patients seen by the general pr actitioner. (C) 2000 Elsevier Science B.V. All rights reserved.