How does bismuth affect the intestines?
Doctors of any specialty often encounter patients suffering from diarrhea syndrome. From a physiological point of view, diarrhea is understood as frequent bowel movements (more than 3 times a day) with liquid or loose feces with a volume of more than 200 g per day.
Table 1. Main pathogens of acute diarrhea
Table 2. Characteristics of patients with acute diarrhea included in the study
Table 3. Satisfaction with the effect (no need to use other antidiarrheal drugs) and duration of diarrhea in patients receiving recommended treatment
Table 4. Antibacterial drugs (first line) used for intestinal decontamination in SIBO
Table 5. Controlled studies in the treatment of urticaria
The division of diarrhea syndrome into acute or chronic is based on the duration of this syndrome. Regardless of the timing and cause of its occurrence, diarrhea significantly reduces the quality of life and carries the threat of developing such serious complications as dehydration and weight loss. Without a doubt, an important aspect of patient management is the need to establish the cause of diarrhea and, accordingly, the etiological approach to its treatment. Since this cannot always be done quickly enough, the problem of symptomatic treatment of this syndrome with drugs with a minimum number of side effects is an independent important medical problem. For this purpose, adsorbents are used: activated carbon, dioctahedral smectite and other astringents, drugs that affect intestinal motility.
The World Gastroenterological Organization has developed clear practical recommendations for the management of patients with acute diarrhea, the criteria for which is a duration of up to 14 days. The etiological factors of acute diarrhea can be divided into 4 main groups: bacterial, viral, parasitic and non-infectious. The most common cause of these is intestinal infections. Every year, 500000 cases of acute diarrhea are registered worldwide; in Russia, the incidence reaches 750-800 cases per 10000 adults (4). According to WHO, acute diarrhea kills about 5 million children worldwide every year (1).
Non-infectious causes include drinking large amounts of beer or coffee, foods rich in fiber, mushrooms, food intolerance, taking a number of medications, as well as the presence of toxic substances in food (heavy metals from cans, nitrates, pesticides, histamine in fish).
Pathogenetically, acute diarrhea is divided into two groups: watery without fever (caused by non-invasive pathogens) and diarrhea with fever and blood in the stool (caused by invasive pathogens) (Table 1).
Watery diarrhea without fever and blood in the stool (or with low fever) is often caused by noninvasive microorganisms that are active only in the intestinal lumen. Adsorbed on the surface of the mucous membrane, they cause diarrhea without invasion of the intestinal epithelium, through the production of enterotoxins and increased fluid secretion. Some microorganisms damage the resorption surface of microvilli, leading to disaccharidase deficiency, e.g. Giardia lamblia. With non-invasive diarrhea, there are no leukocytes in the stool; clinically, along with diarrhea, nausea and sometimes vomiting are often detected. This type of diarrhea is common among travelers (85% of cases). Diarrhea caused by noninvasive microorganisms may be osmotic or secretory. Osmotic diarrhea is based on disaccharidase deficiency in the brush border of the villi and the parietal layer of the mucosa, which leads to the accumulation of high-osmolar substances and impaired resorption of water and electrolytes. The main mechanism of secretory diarrhea is the activation of adenylate cyclases with an increase in the synthesis of cyclic AMP (adenosine monophosphate) and increased secretory function of the epithelium (1).
Other microorganisms penetrate the intestinal epithelium, causing inflammation. Microbial toxins affect the enzyme systems of the intestinal crypts, leading to increased secretion of potassium, sodium, HCO 3 ions and passive loss of water. The favorite location of invasive microorganisms is the large intestine, so stools are usually frequent, with a small amount of blood. There are many leukocytes in the stool; pathogenic microorganisms are detected during culture (3).
People at risk for developing acute diarrhea include: travelers, especially those visiting developing and tropical countries, tourists drinking groundwater, people consuming unusual foods (seafood or fish), or eating out in restaurants and cafes, especially fast food, at banquets and picnics. The risk of diarrhea is increased in homosexuals, sex workers, intravenous drug users and HIV-infected people, in people in psychiatric hospitals and hospices.
Acute traveler’s diarrhea (AT) occurs primarily among international travelers visiting the tropics and subtropics (22) – most often during travel to Asia, Africa and Latin America (34-40%) (7, 18, 35). Risk factors for DP are young age, being in disadvantaged areas in the last 6 months, indiscriminate eating and drinking, and genetic predisposition (16, 28, 35). The main causative agent of DP is enterotoxigenic strains E. Soli (ETEC). Clinical manifestations begin on days 2-3 – abdominal pain, watery stools 3-5 times a day, rarely – hematochezia (10%). The disease usually ends with recovery within 3-5 days.
In general, treatment of acute diarrhea of any etiology begins with the organization of proper nutrition: frequent meals in small portions are necessary, excluding foods containing lactose (milk) and caffeine (they increase diarrhea). Prevention or correction of dehydration involves drinking 2-3 liters of fluid per day (oral saline solutions are used if necessary). Loperamide is used as symptomatic therapy, but its use in febrile patients (temperatures above 38,5ºC), with dysentery or with an increase in leukocytes in the stool is contraindicated (3).
To treat infectious diarrhea, antibacterial drugs are used, taking into account the sensitivity of the microflora secreted. The same applies to DP, for the treatment and prevention of which rifaximin has been shown to be effective due to its low absorption (
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21. Hill DR. Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries // Am J Trop Med Hyg. May 2000; 62(5): 585-9.
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23. Lazenby AJ Collagenous and lymphocytic colitis // Semin Diagn Pathol. 2005 Nov; 22(4): 295-300.
24. Loftus EV Microscopic colitis: epidemiology and treatment // Am J Gastroenterol. 2003 Dec; 98(12 Suppl): S31-6.
25. Nyhlin N. et al. Systematic review: microscopic colitis // Aliment Pharmacol Ther. 2006 Jun 1; 23(11): 1525-34 Comment in: Aliment Pharmacol Ther. 2006 Aug 1; 24(3): 561; author reply 562.
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Purpose of the review: analyze data on the use of bismuth preparations for irritable bowel syndrome.
Basic provisions. Irritable bowel syndrome (IBS) is a common functional disease that significantly reduces quality of life and impairs social functioning, including due to the frequent symptom of diarrhea. Post-infectious IBS can occur after a bacterial, protozoal or viral intestinal infection. It is assumed that the epidemic of the new coronavirus infection affects most of the factors influencing the development of functional disorders and may be one of the reasons for the increase in the post-infectious subtype of IBS. Bismuth salts combine cytoprotective, anti-inflammatory and antibacterial properties. The therapeutic activity of bismuth compounds has been demonstrated in the treatment of diseases of various etiologies accompanied by diarrhea, including post-infectious forms of IBS. The use of bismuth preparations in a therapeutic dose is safe and well tolerated by patients.
Conclusion. The use of bismuth preparations can be considered as one of the approaches in the treatment and prevention of patients with diarrheal variant of IBS, both in the form of monotherapy and as part of combination regimens.
Keywords
About the Developer
Multidisciplinary medical holding SM-Clinic
Russia
Ilchishina Tatyana Alekseevna – candidate of medical sciences, gastroenterologist.
195279, St. Petersburg, Udarnikov Ave., 19/1
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