EFFICACY OF BISMUTH IN ERADICATING HELICOBACTER PYLORI: UPDATES

INTRODUCTION: Helicobacter pylori (H. pylori) is a highly virulent bacterium associated with a variety of gastrointestinal pathologies, such as gastritis, peptic ulcer, and gastric cancer. The use of antibiotics and proton pump inhibitors (PPIs) in the treatment of this bacterium is associated with significant iatrogenic effects, bacterial resistance, and modifications in the patient's intestinal microbiota. In this context, for H. pylori eradication therapy, the concomitant use of bismuth salts (BM), a bacteriostatic and bactericidal agent, has been suggested, demonstrating superior eradication rates compared to regimens without BM. This study aimed to gather scientific evidence obtained from clinical research on therapy based on the combination of pharmaceutical formulations containing BM in H. pylori eradication.METHODOLOGY: This is a systematic review in which scientific articles published in the Pubmed database in the years 2022 and 2023 were selected. The descriptors "bismuth" and "Helicobacter pylori" were combined using the boolean operator AND, following the guidelines recommended by PRISMA. Forty articles were found, of which 04 met the selection criteria and are therefore included in this study.RESULTS: The clinical studies included in the research show that the bioavailability of BM was comparable between quadruple therapy with Vonoprazan and Lansoprazole. Furthermore, therapy with the concomitant use of BM and Vonoprazan was considered safe and well-tolerated, and the presence of food did not compromise the eradication of H. pylori. Additionally, the 14-day quadruple therapy using BM showed better cost-effectiveness than the intensified 14-day triple therapy with metronidazole for the eradication of H. pylori resistant to clarithromycin. Simultaneously, the effectiveness of quadruple therapy in treating H. pylori infection in patients with metagenomic alterations in the intestinal microbiota showed that BM was effective in reversing intestinal dysbiosis in these individuals.CONCLUSION: The results suggest that the use of BM is promising in H. pylori eradication, implying a synergistic action with antibiotics, regardless of the treatment duration, contributing to a higher eradication success rate and promoting better medication tolerance in patients.