A review of rifaximin and bacterial overgrowth in poorly responsive celiac disease

Abstract

A proportion of patients with celiac disease have a poor response to a gluten-free diet, which may be due to small-intestinal bacterial overgrowth (SIBO). Treatment with rifaximin is often used in the clinical setting, but there is limited literature to support this practice. In addition, challenges in the diagnosis of SIBO confound response interpretation. Our recent placebo-controlled trial did not demonstrate any improvement in gastrointestinal symptoms after treatment with rifaximin and casts doubt on the utility of lactulose-hydrogen breath testing for SIBO in this population.

Small intestinal bacterial overgrowth and celiac disease: A systematic review with pooled‐data analysis

“…In other two papers, the calculated prevalence of SIBO in unresponsive CD was 66% and 48%, respectively, and the remission of symptoms was achieved after rifaximin treatment. For these reasons, some authors recommend to detect and treat SIBO in patients with CD who do not improve their clinical status after GFD . Despite the main reasons of unresponsiveness to diet in CD are known to be represented by gluten contamination or refractory CD, SIBO could be considered in this condition.…”

Predictors of persistent symptoms and reduced quality of life in treated coeliac disease patients: a large cross-sectional study

“…There is also evidence suggesting that the symptoms in IBS might be caused by continuous low-grade small-bowel mucosal inflammation [30,31,33], a condition which may persist in coeliac disease despite a strict gluten-free diet [34,35]. Finally, small-intestinal bacterial overgrowth may account for symptoms in both coeliac disease and IBS and is also accompanied by mucosal inflammation [33,36,37]. Whatever mechanisms lie behind the persistent symptoms, our results indicate that they could be ameliorated by diagnosing coeliac disease as early as possible.…”

Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO

“…Rifaximin is a new antibiotic, not absorbed in the gastrointestinal tract. Its use reduces the symptoms of excessive gas retention [38]. A doubleblind placebo-controlled study shows that using rifaximin at a dose of 550 mg three times daily for two weeks provides relief in IBS symptoms such as abdominal pain, diarrhea and bloating [39].…”

“…In some, a spectacular improvement is observed, while others require multiple repetition of antibiotic therapy, and sometimes it is necessary to use rotational therapy. The effectiveness of rifaximin in reducing SIBO symptoms may be effected in different ways [38]. Interaction between rifaximin and warfarin is suspected [40].…”

“…SIBO may be a cause of a poor response to a gluten-free diet and the persistence of celiac disease symptoms. Uncontrolled studies showed the effectiveness of rifaximin in the symptomatic treatment of celiac disease poorly responding to therapy [38]. However, a double-blind American randomized study assessing the effectiveness of rifaximin in poorly responding celiac disease revealed that it does not alleviate ailments in these patients, and the hydrogen breath tests cannot answer the question which group of patients could respond favorably to antibiotic therapy [65].…”