The importance of bismuth preparations for increasing the effectiveness of therapy for Helicobacter pylori infection

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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