Bismuth subsalicylate (Pepto-Bismol), as an absorbent, has which of the following mechanisms of action?
A. Decreased GI motility.
B. Decreased gastric secretions.
C. Increased fluid absorption.
D. Binding to diarrhea-causing bacteria for excretion.
Correct Answer: D. Binding to diarrhea-causing bacteria for excretion.
Absorbent antidiarrheal medications bind to diarrhea-causing bacteria to form a nonabsorbable complex, which is then excreted in the stool. Bismuth subsalicylate (BSS) exhibits many of its properties due to its formulation as an insoluble salt of salicylic acid and trivalent bismuth. The mechanism of action through which BSS works is complex.
Option A: In the stomach, BSS hydrolyzes into two compounds, bismuth, and salicylic acid. The salicylate compound is almost completely absorbed into the bloodstream, while bismuth salt is minimally absorbed.
Option B: The bismuth that remains in the gastrointestinal tract forms other bismuth salts. These bismuth salts contain bactericidal and antimicrobial activity, and prevent bacteria from binding and growing on the mucosal cells of the stomach. This is the mechanism by which BSS helps eradicate H. pylori.
Option C: The prevention of bacterial binding to the mucosal cells provides many benefits, which include prevention of intestinal secretion, promotion of fluid absorption, reduction of inflammation, and promotion of the healing of any present ulcer in the stomach.
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