Snapshot A 19-year-old college student presents to the university travel clinic for an evaluation prior to embarking on a global health research project in northern India. She has no significant medical history, and has a copper intrauterine device for birth control. Her physical exam is grossly unremarkable. In addition to vaccinations, the physician suggests that the patient purchase Pepto-Bismol over the counter to manage any traveler's diarrhea while abroad, but recommends avoiding concomitant consumption of aspirin. Introduction Drugs bismuth subsalicylate sucralfate Mechanism of action provides physical protection to ulcer base requires low pH to activate into paste consistency that adheres to mucosal wall may be inhibited by antacids may decrease absorption of other medications does not decrease acid secretion or neutralize acid response Clinical use peptic ulcer disease ↑ ulcer healing ↓ ulcer recurrence traveler's diarrhea triple therapy of H. pylori ulcers bismuth subsalicylate metronidazole tetracycline (or amoxicillin) may also use proton pump inhibitor Adverse effects sucralfate constipation bismuth subsalicylate harmless black coloring of stool Reye's syndrome in children recovering from chickenpox or influenza (due to salicylate component)