Bismuth (Bi) is a chemical element whose atomic number is 83. Bismuth-containing compounds include cosmetics (bismuth oxychloride) and certain drugs. Bismuth is also used in some medical procedures. Bismuth has been used for approximately a hundred years for stomach and intestinal conditions and was the first drug shown to affect the progression of peptic ulcer disease. The historical use of bismuth has been discussed in various reviews.
Although the element bismuth has been used since at least the 18th Century, most bismuth-containing products available on the market now are multi-ingredient products or are used in combination with other drugs. These multi-ingredient products will be only briefly discussed in this monograph.
Examples of bismuth products used in medicine include bismuth subnitrate, bismuth subcarbonate, bismuth subsalicylate (e.g., Pepto-Bismol®, Kaopectate®), bismuth subgallate (e.g., Devrom®), colloidal bismuth subcitrate (e.g., De-Nol®), and ranitidine bismuth subcitrate.
Some preliminary evidence suggests that bismuth carbomer enemas may reduce pouchitis (inflammation in the pouch) that may occur after colon removal. Bismuth subnitrate has been used for treatment of Helicobacter pylori infection, typically in combination with antibiotics, with limited evidence of benefit. Bismuth subgallate has been studied for controlling odor after an ileostomy (a hole surgically constructed in the abdomen to eliminate waste).
214Bi, basic bismuth carbonate (BSC), basic bismuth gallate (BSG), basic bismuth nitrate (BSN), basic bismuth salicylate (BSS), Bi, Bi2O3, biscu, Bismatrol®, Bismatrol® Extra Strength, Bismed®, bismuth aluminate (BA), bismuth ammonium citrate, bismuth biskalcitrate, bismuth carbomer enemas, bismuth gallate, bismuth (III), bismuth oxynitrate, bismuth phosphate, bismuth salts, bismuth subgallate, bismuth subnitrate, bismuth subnitrate suspension (B), bismuth subsalicylate, bismuth sulfate agar (BSA), bismuth tribromophenate (Xeroform®), bismuth-207, bismuth-212, bismuth-213, bismuth-ethylenediamine tetraacetate bisodium (bi-EDTA), bismuthi subcitras colloidal, bismuth-peptide complex (BPC, bicitropeptide), BSS, calcium acexamate-light bismuth nitrate, colloidal bismuth, colloidal bismuth pectin (CBP), colloidal bismuth subcitrate (CBS), De-Nol®, Gastrin®, Gastrocaps®, GR122311X, Kaopectate®, karaya bismuth, micronized bismuth subnitrate, Pepto-Bismol®, Pepto-Bismol® Easy-to-Swallow Caplets, Pepto-Bismol® Maximum Strength, PMS-bismuth subsalicylate, Q-ULCER®, ranitidine bismuth citrate (Pylorid®, RBC, Rb, Tritec®), Rbc, Roter®, tripotassium dicitrato bismuthate (TBS, TDB, Ventrisol®), tripotassium dicitratobismuthate (De-Nol®), ulcedal, ulcerine, vicalin, wikalina, Xeroform®.
Note: This monograph focuses on bismuth and bismuth subcarbonate, subgallate, or subnitrate single-arm studies. Bismuth subsalicylate, colloidal bismuth subcitrate, bismuth aluminate, and ranitidine bismuth products are alluded to, but not expanded on.
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Gastritis (stomach lining inflammation)
According to human research, bismuth subnitrate may reduce the acidity of the stomach, as well as increase the production of a substance that improves ulcer healing. Also, a bismuth-protein complex may coat ulcers and allow healing to occur. Bismuth therapy for gastritis has been investigated in a few preliminary clinical trials. Well-designed studies are required before conclusions can be drawn.
Gastrointestinal conditions (stomach problems)
Bismuth has been used traditionally for stomach problems. Limited research has investigated the use of bismuth subgallate to control the odor associated with ileostomies (a surgical opening in the belly wall to allow waste to be removed). Further well-designed trials are required before conclusions can be drawn.
Helicobacter pylori infection
Bismuth has been established as a safe and well-tolerated treatment for
Kidney disorders (renal cysts)
According to research in humans, bismuth subnitrate, ginseng, and tang-kuei ten may reduce kidney dysfunction associated with cisplatin treatment, although conflicting results exist. Furthermore, at least one case study suggests that high doses of bismuth may cause sudden and severe kidney failure. More information is needed before conclusions can be drawn.
Bismuth has been used traditionally for gastric concerns. The use of bismuth subgallate to control the odor associated with ileostomies (a surgical opening in the belly wall to allow waste to be removed) was investigated in humans. Also, limited research indicates that bismuth may prevent ulcer recurrence similarly to cimetidine. Further information is required before conclusions can be drawn.
Pouchitis (intestinal inflammation)
A limited number of studies have investigated the use of bismuth carbomer enemas for chronic pouchitis, which is the inflammation of a surgically constructed bowel pouch. However, the results from these studies were conflicting, so further information is required before conclusions can be drawn.
Tonsillitis (swelling of the tonsils)
A limited number of studies have investigated the use of bismuth subgallate for tonsillectomy (tonsil removal). Although evidence from clinical trials examining the effect of gauze containing bismuth and adrenaline suggests improved healing, only one of two trials examining the effect of bismuth alone agreed with these results. Further information is required before conclusions can be drawn.