A Randomized Double-Blind Placebo-Controlled Trial of Rifaximin in Patients with Abdominal Bloating and Flatulence

Sharara, Ala I.; Aoun, Elie; Abdul‐Baki, Heitham; Mounzer, Rawad; Sidani, Shafik; El-Hajj, Ihab

doi:10.1111/j.1572-0241.2006.00458.x

Cited by 277 publications

(244 citation statements)

References 28 publications

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“…Rifaximin, in particular, has generated much interest in recent years [Lembo et al 2008;Ringel et al 2008;Pimentel et al 2006;Sharara et al 2006]. This drug is minimally absorbed providing high luminal bioavailability with few systemic side effects [Scarpignato and Pelosini, 2006].…”

Section: Antibioticsmentioning

confidence: 99%

Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents

Sainsbury

Ford

2010

Therap Adv Gastroenterol

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Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract of unknown etiology. The diagnosis of IBS is made clinically, using symptom-based criteria such as the Manning or Rome criteria. Medical therapy for this condition has traditionally been directed towards symptom relief, using fiber or antispasmodic agents. In recent years, emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT 3 antagonists, 5-HT 4 agonists, and probiotics in the short-term treatment of IBS, although whether these therapies influence the long-term course of the disease is unknown. Increasing knowledge regarding the pathophysiological mechanisms underlying IBS has resulted in a number of novel molecular treatments, which show promise. These include therapies targeting gastrointestinal mucosal chloride channels and guanylate cyclase-C receptors, as well as highly selective agents influencing serotonergic transmission that, at the time of writing, do not appear to have any severe deleterious effects. In this article we provide a summary of current and emerging therapies in this field.

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Section: Antibioticsmentioning

confidence: 99%

Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents

Sainsbury

Ford

2010

Therap Adv Gastroenterol

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“…The rationale underling this drug is that an intestinal dysbiosis could increase gas production. In 2006, Sharara et al [110] demonstrated that a 10 d course of rifaximin is effective in reducing bloating symptoms without significant adverse events. Also, another interesting double blind, randomized, placebo-controlled trial, showed that patients with IBS (based on Rome Ⅰ criteria) treated with rifaximin reported a significant improvement in bloating and IBS symptoms compared to patients who received placebo (p = 0.010) [111] .…”

Section: Treatmentmentioning

confidence: 99%

“…A combination of simethicone plus activated charcoal and magnesium oxide was tested against placebo in a double blind, ran- [136] Ⅱ Lactobacillus plantarum 299v: improvement [137] Ⅲ Multispecies: improvement [138] Ⅲ Symbiotics Symbiotic mixture: no benefits [115,116] Ⅲ Antibiotics Rifaximin: reduction in bloating-specific scores [110] Ⅱ Rifaximin: improvement (39.5% vs 28.7%) [112] Ⅱ Prokinetics Tegaserod: improvement [120] Ⅰ Tegaserod: improvement [139][140][141] Ⅱ Tegaserod: no differences vs placebo [142] Ⅱ Prucalopride: improvement [126] Ⅱ Antispasmodic Otilonium bromide improvement [143] Ⅱ Mebeverine vs Otilonium bromide: improvement significantly achieved by both treatments [144] Ⅱ Antidepressant Paroxetine: no difference vs placebo [145] Ⅰ Citalopram: improvement [146] Ⅱ Fluoxetine: improvement [147] Ⅱ domized, multicenter trial in patients with FD meeting the Rome Ⅲ criteria [134] . This study showed a reductions in the intensity of post-prandial fullness, epigastric pain, epigastric burning and bloating in the active treatment arm compared to placebo [134] .…”

Section: Treatmentmentioning

confidence: 99%

Bloating and functional gastro-intestinal disorders: Where are we and where are we going?

Iovino

Bucci

Tremolaterra

et al. 2014

WJG

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Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients. This symptom has been described with various definitions, such as sensation of a distended abdomen or an abdominal tension or even excessive gas in the abdomen, although bloating should probably be defined as the feeling (e.g. a subjective sensation) of increased pressure within the abdomen. It is usually associated with functional gastrointestinal disorders, like irritable bowel syndrome, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome Ⅲ criteria named functional bloating. In terms of diagnosis, major difficulties are due to the lack of measurable parameters to assess and grade this symptom. In addition, it is still unclear to what extent the individual patient complaint of subjective bloating correlates with the objective evidence of abdominal distension. In fact, despite its clinical, social and economic relevance, bloating lacks a clear pathophysiology explanation, and an effective management endorsement, turning this common symptom into a true challenge for both patients and clinicians. Different theories on bloating etiology call into questions an increased luminal contents (gas, stools, liquid or fat) and/or an impaired abdominal empting and/or an altered intra-abdominal volume displacement (abdomino-phrenic theory) and/ or an increased perception of intestinal stimuli with a subsequent use of empirical treatments (diet modifications, antibiotics and/or probiotics, prokinetic drugs, antispasmodics, gas reducing agents and tricyclic antidepressants). In this review, our aim was to review the latest knowledge on bloating physiopathology and therapeutic options trying to shed lights on those processes where a clinician could intervene to modify disease course. Key words: Bloating; Functional gastro-intestinal disorders; Irritable bowel syndrome; Constipation; Diarrhea Core tip: Bloating is one of the most common and bothersome symptoms complained by a large proportion of patients, mostly with functional gastrointestinal disorders, but when bloating is not part of another functional bowel or gastrointestinal disorder it is included as an independent entity in Rome Ⅲ criteria named functional bloating. Despite its clinical, social and economic Iovino P et al . Bloating and functional gastro-intestinal disorders relevance, bloating lacks a clear pathophysiology explanation and an effective management endorsement. Moreover, it is unclear to what extent subjective complaint of bloating correlates with the objective evidence of abdominal distension. The aim of this paper is to review the latest knowledge on bloating and to explore future research directions to improve its management.

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“…In previous studies, normalization of the results of the breath test in IBS patients after antibiotic therapy has been shown to be correlated with a successful response to antibiotic therapy. 86,92,93,96 The predictive value of a positive lactulose breath test has been disappointing, however, in selecting patients who will respond. [97][98][99] In a recent prospective study that used upper-gut aspiration culture for diagnosing SIBO, IBS patients with SIBO had greater symptom alleviation than patients without SIBO (87.5% vs 25%) 1 month after the administration of antibiotics.…”

Section: Antibiotics In Functional Bowel Disordersmentioning

confidence: 99%

“…91 Many previous studies reported that rifaximin treatment in SIBO and IBS patients had significant benefits compared with placebo. 87,[92][93][94] In the 2 largest phase 3 trials involving people with non-constipated IBS (TARGET 1 and 2), treatment with rifaximin 550 mg 3 times a day for 2 weeks achieved adequate alleviation of the global IBS symptoms (40.7% vs 31.7% for placebo, pooled; P < 0.001) and bloating (40.2% vs 30.3% for placebo, pooled; P < 0.001) during the first 4 weeks after treatment. 87 In addition, a Although it is generally acknowledged that rifaximin leads to short-term clinical improvements in some IBS patients, there are several points to be considered before promoting the widespread use of rifaximin.…”

Section: Antibiotics In Functional Bowel Disordersmentioning

confidence: 99%

Therapeutic Modulation of Gut Microbiota in Functional Bowel Disorders

Lee

Choi

Ryu

et al. 2017

J Neurogastroenterol Motil

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Functional bowel disorders (FBDs) are functional gastrointestinal disorders with symptoms attributable to the middle or lower gastrointestinal tract. These include irritable bowel syndrome, functional bloating, functional constipation, functional diarrhea, and unspecified FBD. Increasing evidence has emerged of late that intestinal microbiota is involved in the pathogenesis of FBDs. In this review, the therapeutic benefits and future perspectives of the currently available strategies for modifying the gut microbiota in FBDs are described, focusing primarily on irritable bowel syndrome and functional constipation.

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A Randomized Double-Blind Placebo-Controlled Trial of Rifaximin in Patients with Abdominal Bloating and Flatulence

Cited by 277 publications

References 28 publications

Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents

Treatment of irritable bowel syndrome: beyond fiber and antispasmodic agents

Bloating and functional gastro-intestinal disorders: Where are we and where are we going?

Therapeutic Modulation of Gut Microbiota in Functional Bowel Disorders

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