Oral bismuth for chronic intractable diarrheal conditions?

Thazhath, Sony S, Haque, Mazhar and Florin, Timothy H (2013) Oral bismuth for chronic intractable diarrheal conditions?. Clinical and Experimental Gastroenterology, 6 1: 19-25. doi:10.2147/CEG.S41743

Author Thazhath, Sony S
Haque, Mazhar
Florin, Timothy H
Title Oral bismuth for chronic intractable diarrheal conditions?
Journal name Clinical and Experimental Gastroenterology   Check publisher's open access policy
ISSN 1178-7023
Publication date 2013-03
Year available 2013
Sub-type Article (original research)
DOI 10.2147/CEG.S41743
Open Access Status DOI
Volume 6
Issue 1
Start page 19
End page 25
Total pages 7
Place of publication Macclesfield, United Kingdom
Publisher Dove Medical Press
Collection year 2014
Formatted abstract
Objective: Bismuth has antidiarrheal, antibacterial, and anti-inflammatory properties. We report our single-center experience with oral colloidal bismuth subcitrate (CBS) treatment for patients with chronic intractable diarrhea.

Method: We interrogated our web-based Inflammatory Bowel Disease Clinical and Research database to ascertain clinical details on all patients in our tertiary hospital gastroenterology service treated with CBS between 2000 and 2010. Treatment responses were based on prospective scoring of daily number of liquid stools. Responses were recorded prior to commencement of CBS and at follow-up visits over 12 months.

Results: Thirty-one patients, mean age 47 years (range 17-79 years) and a mean duration of diarrhea of 22 weeks (range 6-104 weeks), were prescribed CBS at doses ranging from 120 mg to 480 mg/day for $1 month. Of these, 23 patients (74%) had an initial clinical response and 12 (39%) who continued with this treatment had a sustained clinical response at 1 year. Twelve patients with pouchitis and four patients with indeterminate colitis had initial responses of 92% and 75%, respectively, and sustained responses of 50% and 75%, respectively. Ulcerative colitis patients (n = 5) responded poorly with respect to both initial and sustained responses. Three patients with microscopic colitis showed encouraging initial response of 100% but did not have any sustained benefit. Three of four patients with diarrhea-predominant irritable bowel syndrome (dIBS) had an initial response and two (50%) had good sustained responses. There were no serious adverse events. One patient stopped therapy because of nausea.

Conclusion: This is the largest report of oral bismuth treatment in chronic intractable diarrhea. CBS is cheap and appears to have the potential to be effective for ameliorating diarrheal symptoms in indeterminate colitis, pouchitis, and dIBS. An appropriately powered, blinded, randomized, controlled study appears warranted to establish the position of oral bismuth in routine practice.
Keyword Colloidal bismuth subcitrate
Inflammatory bowel disease
Oral bismuth
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2014 Collection
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Created: Thu, 28 Nov 2013, 14:35:49 EST by System User on behalf of School of Medicine