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Background/Aims: This study aimed to evaluate the efficacy and the immunomodulatory effect of rifaximin as another promising prophylactic therapy against spontaneous bacterial peritonitis (SBP) in cirrhotics. Materials and Methods: Seventy cirrhotic patients with ascites were included in the study. Patients were divided into two groups in a randomized single-blind fashion. Group one (n=40) received rifaximin and group two (n=30) received norfloxacin (control group). The treatment duration was 6 months. Serum levels of tumor necrosis factor alpha (TNF-α), interleukin-6 ( IL-6), and interleukin-10 (IL-10) were the primary inflammatory markers of the study to evaluate the effect of the medications used. Results: Three months after treatment, five cases on norfloxacin therapy showed SBP, whereas all cases on rifaxmine therapy were free from SBP. In addition, there was no significant difference between patients on rifaximin and norfloxacin therapy with respect to TNF-α, IL-6, and IL-10 serum levels (p>0.05). Furthermore, patients on both rifaximin and norfloxacin therapies showed a statistically significant decrease in TNF-α and IL-6 serum levels compared with their baseline levels (p=0.000 and p=0.000, respectively). In contrast, serum IL-10 showed a statistically significant increase in both groups in comparison with its baseline level (p>0.00). Six-month after treatment, patients on rifaximin therapy showed more effective remission from SBP than those on norfloxacin therapy. Conclusion: In conclusion, the use of rifaximin not only prevents bacterial translocation but also modulates the immune response of the inflammatory and the anti-inflammatory cytokines in SBP patients. However, the efficacy and the immunomodulatory effect of rifaximin in the prophylaxis of SBP in cirrhotics needs further prospective large-scale, double-blind studies.

We demonstrated a significant association between MetS and FPHL. Women with FPHL, particularly if associated with an increased WC or hypertension, should be screened for MetS criteria for early identification and management.

In this retrospective study, the presence and appearance of gastric varices were analyzed among patients presenting at Kasr El Aini Hospital with variceal bleeding during the period from 1984 to 1989. Two groups of patients were studied. The first group included 970 patients with documented variceal bleeding with no history of sclerotherapy. Of these patients 6.7%, had concomitant gastric varices, and 27.1% had direct gastric extension of esophageal varices (mostly of grade 3). Gastric varices alone, without esophageal varices, were found in five cases (0.5%). The second group was a subgroup, and included 376 patients who underwent complete sclerotherapeutic eradication of varices restricted to the esophagus and were without gastric varices at the first presentation. Eleven of these patients (2.9%) developed secondary gastric varices. There was no correlation between the risk of bleeding from primary gastric varices (seen at the first presentation) and the grade of the esophageal varices. There were more bleeding episodes from large gastric varices (35.4% for the cauliflower and 16.9% for the cystic forms) than from the small varices, i.e. ruga-like and network-like gastric varices. The study also shows that the secondary development of gastric varices after endoscopic variceal sclerotherapy is a rare event, and that there was no risk of bleeding from the secondary gastric varices. Patients with esophageal varices with gastric extension had a small risk of bleeding from their gastric varices (5.2%).