Bismuth has been used to treat dyspepsia for more than a hundred years, and has now become an important element in the treatment of peptic ulcer disease. Less than 1% of ingested bismuth is absorbed in the gastrointestinal tract and is excreted in the urine. Bismuth forms a protective coating on the mucosa, it stimulates secretion of bicarbonate and has an effect on the G-cell and Helicobacter pylori. Bismuth gives equal ulcer healing rates as H2-receptor blocking agents, but causes significantly less relapses. Triple treatment with bismuth, tetracycline and metronidazole eradicates H pylori in 95% of patients. Bismuth accumulates in the body during treatment and is neurotoxic, and it cannot be excluded that even short-term treatment may cause subclinical damage to the central nervous system.