Currently, finding new indications for the use of a particular drug is one of the main ways to increase drug sales. This fact is very appreciated by researchers, because it sometimes allows them to receive considerable funds for the implementation of their ideas. A change in the traditional attitude towards an apparently well-known drug often leads to new methods of therapy (aspirin), or at least to an increase in the number of publications of a certain type. Sometimes such research is also interesting for voluntary patients (for example, the study of sildenafil for the treatment of pulmonary hypertension in a group of healthy male volunteers). An example of a study is presented for your attention, in which, it seems, everyone participated with pleasure, except for the patients.

Bismuth preparations, and in particular tripotassium bismuth dicitrate, became world famous and popular after including them in the algorithm for treating infections caused by H. pylori. The therapeutic effect is based on the bactericidal properties of the drug, which forms complexes on the bacterial wall, inhibits bacterial enzymes (urease, catal, lipase, etc.), inhibiting the adhesion of H. pylori to gastric epithelial cells. In addition, bismuth preparations are traditionally used as astringents for the treatment of inflammatory diseases of the stomach.

Until now, this drug has been used to treat pathology of the upper gastrointestinal tract. However, a number of researchers have attempted to justify its use in the treatment of irritable bowel syndrome, or rather irritable bowel syndrome after an intestinal infection. (Note that from the stomach to the distal intestine is far enough). In this case, cases with the presence of pathogenic microorganisms, for example, C.dificile, were bacteriologically excluded. For material collection, all patients underwent fibrogastrointestinoscopy with a biopsy.

The study included patients who had previously been treated unsuccessfully at the place of residence. Exhausted by ineffective therapy, they were sent to a specialized center. A history of the disease lasted two to three years. Patients with diarrhea up to 6 times a day, flatulence, cramps and abdominal pain were divided into two groups. The first (test) received a bismuth preparation, the second (control) antacid three times a day. As a result, both were deprived of the standard complex therapy for irritable bowel syndrome, namely antispasmodics, intestinal antiseptics, activated carbon, enterosorbents and probiotics. By request only, but not more than three times a day, drotaverine hydrochloride is not the most effective medication for relieving abdominal pain. Of course, all patients followed a special diet.

The patients were observed for 3 weeks. As a result, it turned out that in the group of patients receiving an antacid, no change occurred, all the same clinical manifestations persisted: repeated loose stools, abdominal pain and flatulence. But in the study group, the frequency of bowel movements decreased to 2-3 times a day (just that, and not all patients had bowel movements formed), bloating decreased, abdominal pain became less common. But not gone!

After three weeks of treatment in a specialized gastroenterological department, practically nothing has changed in the two groups of patients. These results were not surprising to researchers who noted significant changes in the faecal microflora in patients in these groups before and after treatment and recommended the inclusion of bismuth (De-Nol) drugs in the treatment of patients with irritable bowel syndrome associated with intestinal dysbiosis, as bismuth can suppress conditionally pathogenic microflora growth (no pathogenic microorganisms were found in patients).

Obviously, there are two other patient groups missing from the study. Groups of patients receiving conventional complex therapy and groups of patients on placebo. A comparison of the results with these groups could perhaps reveal the true meaning of the drug in intestinal pathology. Patients on a special diet and a placebo, and even more so after standard treatment, would barely have made as many complaints in three weeks. Particular pity is caused by patients who have received an extremely effective antacid in this situation. It seems that three weeks of treatment will not be forgotten anytime soon. Unfortunately, the future fate of these patients is unknown. Perhaps they received the same effective treatment, or perhaps they started counting the third or fourth year of their suffering. Another option is possible - the transfer to bismuth therapy, which seems almost equivalent to previous versions of event development.

Only one fact pleases. The study group (n = 20) and the control group (n = 10) were, to put it mildly, small, and the course of therapy lasted only 21 days. Considerable sums spent on this study by one of the major pharmaceutical companies have not been in vain.