medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-390medsovet-9458Research ArticleЗАБОЛЕВАНИЯ ПИЩЕВОДА И ЖЕЛУДКАESOPHAGEAL AND GASTRIC DISEASESЗначение препаратов висмута для повышения эффективности терапии инфекции Helicobacter pyloriThe importance of bismuth preparations for increasing the effectiveness of therapy for Helicobacter pylori infectionhttps://orcid.org/0000-0002-0535-2916ДроздовВ. Н.DrozdovV. N.

Дроздов Владимир Николаевич - д.м.н., профессор кафедры клинической фармакологии и пропедевтики внутренних болезней.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Vladimir N. Drozdov - Dr. Sci. (Med.), Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

vndrozdov@yandex.ruhttps://orcid.org/0000-0002-5484-0537ХалаиджеваК. Н.KhalaidzhevaK. N.

Халаиджева Ксения Николаевна - к.м.н., ассистент кафедры клинической фармакологии и пропедевтики внутренних болезней.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Kseniya N. Khalaidzheva - Cand. Sci. (Med.), Assistant Professor, Department of Clinical Pharmacology and Propaedeutics of Internal Medicine, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

Kseniyakhalaidzheva@mail.ruhttps://orcid.org/0000-0002-7163-7119СереброваС. Ю.SerebrovaS. Yu.

Сереброва Светлана Юрьевна - д.м.н., профессор кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); ведущий научный сотрудник, НЦЭСМП.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 127051, Москва, Петровский бульвар, д. 8, стр. 2

Svetlana Yu. Serebrova - Dr. Sci. (Med.), Professor of Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University); Chief Scientific Researcher, Scientific Centre for Expert Evaluation of Medicinal Products.

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051

svetaserebrova@mail.ruhttps://orcid.org/0000-0001-6528-1585ЛазареваН. Б.LazarevaN. B.

Лазарева Наталья Борисовна - д.м.н., профессор кафедры клинической фармакологии и пропедевтики внутренних болезней.

119991, Москва, ул. Трубецкая, д. 8, стр. 2

Natalia B. Lazareva - Dr. Sci. (Med.), Professor of the Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University).

8, Bldg. 2, Trubetskaya St., Moscow, 119991

lazareva_n_b@staff.sechenov.ruhttps://orcid.org/0000-0003-1972-4386ЕсаковаЕ. Ю.EsakovaE. Yu.

Есакова Елена Юрьевна - к.фарм.н., ассистент кафедры клинической фармакологии и пропедевтики внутренних болезней, ПМГМУ им. И.М. Сеченова (Сеченовский Университет); ведущий аналитик, НЦЭСМП.

119991, Москва, ул. Трубецкая, д. 8, стр. 2; 127051, Москва, Петровский бульвар, д. 8, стр. 2

Elena Yu. Esakova - Cand. Sci. (Pharm.), Assistant Professor of Department of Clinical Pharmacology and Propaedeutics of Internal Diseases, Sechenov First Moscow State Medical University (Sechenov University); Leading Analyst of the Scientific Department of Clinical Pharmacology, Scientific Centre for Expert Evaluation of Medicinal Products.

8, Bldg. 2, Trubetskaya St., Moscow, 119991; 8, Bldg. 2, Petrovsky Boulevard, Moscow, 127051

demchenkova@mail.ruПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian FederationПервый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет); Научный центр экспертизы средств медицинского примененияРоссияSechenov First Moscow State Medical University (Sechenov University); Scientific Centre for Expert Evaluation of Medicinal ProductsRussian Federation202517102025015815Copyright © Дроздов В.Н., Халаиджева К.Н., Сереброва С.Ю., Лазарева Н.Б., Есакова Е.Ю., 20252025Дроздов В.Н., Халаиджева К.Н., Сереброва С.Ю., Лазарева Н.Б., Есакова Е.Ю.Drozdov V.N., Khalaidzheva K.N., Serebrova S.Y., Lazareva N.B., Esakova E.Y.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9458

Висмут относится к группе тяжелых металлов, но обладает самой низкой среди них токсичностью, в том числе из-за слабой растворимости в водных и биологических средах. При этом соединения висмута являются перспективными для использования в медицине благодаря своей высокой биологической активности. Эти вещества находят применение в терапии различных заболеваний, включая онкологические, поскольку обладают антипролиферативной активностью (индуцируют апоптоз, ингибируют протеасомы, модулируют сигнальные пути). Для лечения инфекции Helicobacter pylori применяются лекарственные препараты в основном на основе висмута трикалия дицитрата, демонстрирующего высокую эффективность и низкую частоту резистентности к нему возбудителя. Проблемными аспектами применяемых при эрадикации H. pylori схем являются их эмпирический выбор при отсутствии рутинного персонализированного подхода к нему, низкий уровень контроля эрадикации рекомендованными для этой цели методами, чувствительность фармакодинамических эффектов компонентов схем к фармацевтическим свойствам друг друга и упомянутая резистентность возбудителя к антибактериальным препаратам. Препараты на основе висмута трикалия дицитрата, обладающие собственной бактерицидной активностью, не зависящей от условий среды, несколькими механизмами действия, не индуцирующие известные пути развития резистентности, при применении в составе различных эрадикационных схем увеличивают их эффективность, не снижая переносимости. Основные результаты многочисленных клинических исследований подтверждают приведенные положения. Дополнительным преимуществом включаемых в лекарственные препараты соединений висмута является их гастропротективное действие, позволяющее расширить спектр показаний за счет патологии желудка, сопровождающейся образованием эрозивных и язвенных дефектов его слизистой оболочки (эрозивный гастрит, язвенная болезнь и др.), а также противодиарейный эффект, имеющий клиническое значение при синдроме раздраженного кишечника и функциональной диарее. Безопасность применения висмута трикалия дицитрата в низких дозах и при проведении коротких курсов подтверждена крупными метаанализами; серьезные побочные эффекты встречаются крайне редко и не связаны с нейротоксичностью. Представленный комплекс данных свидетельствует о перспективности дальнейшего изучения и клинического применения висмута в противоопухолевой, антибактериальной и гастроэнтерологической практике.

Bismuth belongs to the group of heavy metals, but it has the lowest toxicity among them, including due to its weak solubility in aqueous and biological media. At the same time, bismuth compounds are promising for use in medicine due to their high biological activity. These substances are used in the treatment of various diseases, including cancer, because they have antiproliferative activity (induce apoptosis, inhibit proteasomes, modulate signaling pathways). For the treatment of Helicobacter pylori infection, drugs are used, mainly based on bismuth tricalcium dicitrate, which demonstrates high efficacy and a low incidence of resistance to the pathogen. Problematic aspects used in H. eradication pylori schemes are their empirical choice in the absence of a routine personalized approach to it, a low level of eradication control by the methods recommended for this purpose, the sensitivity of the pharmacodynamic effects of the scheme components to the pharmaceutical properties of each other, and the mentioned resistance of the pathogen to antibacterial drugs. Preparations based on bismuth tricalcium dicitrate, which have their own bactericidal activity independent of environmental conditions, several mechanisms of action that do not induce known pathways of resistance development, when used as part of various eradication regimens, increase their effectiveness without reducing tolerability. The main results of numerous clinical studies confirm these statements. An additional advantage of bismuth compounds included in medicinal preparations is their gastroprotective effect, which makes it possible to expand the range of indications due to gastric pathology, accompanied by the formation of erosive and ulcerative defects of its mucous membrane (erosive gastritis, peptic ulcer, etc.), as well as an antidiarrhoeal effect, which is of clinical importance in irritable bowel syndrome and functional diarrhea. The safety of using bismuth tricalcium dicitrate in low doses and during short courses has been confirmed by large meta-analyses; serious side effects are extremely rare and are not associated with neurotoxicity. The presented set of data indicates the prospects for further study and clinical use of bismuth in antitumor, antibacterial and gastroenterological practice.

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The authors declare that there are no conflicts of interest present.