Gastric persorption of bismuth from ranitidine bismuth citrate

SUMMARY Aim: To determine whether bismuth penetrates the gastric mucosa after dosing with ranitidine bismuth citrate. Methods: Twelve patients presenting with dyspepsia were randomized to receive either ranitidine bismuth citrate or placebo, 20–40 min prior to endoscopy. Biopsies were taken from four sites during endoscopy: the first and second parts of the duodenum, the antrum, and the body of the stomach. Biopsies were analysed by electron microscopy and X-ray microanalysis. Results: Bismuth particles were found to be interposed between epithelial cells in the antral mucosa of three of eight patients who were dosed with ranitidine bismuth citrate. Columns of bismuth particles could be tracked down the lamina propria and were seen to be surrounding blood vessels. Bismuth particles were observed in the inter- and intra-cellular channels of the endothelial cells of the blood vessels in the lamina propria and also close to the luminal surface of the endothelial cell. This process of persorption was similar to that described in a previous report of electron microscopy appearances of the gastric antrum after dosing with tripotassium dicitrato bismuthate, but was quantifiably smaller and not observed in all the patients dosed with ranitidine bismuth citrate. No penetration of the mucosa by bismuth particles was seen in the body of the stomach or the duodenum. Conclusion: Penetration of bismuth particles into the gastric mucosa may occur after oral dosing with ranitidine bismuth citrate.