Intestinal decontamination improves liver haemodynamics in patients with alcohol‐related decompensated cirrhosis

Vlachogiannakos, John; Saveriadis, A.; Viazis, Nikos; Theodoropoulos, Ioannis; Foudoulis, Kimon; Manolakopoulos, Spilios; Raptis, Sotirios A.; Karamanolis, Dimitrios G.

doi:10.1111/j.1365-2036.2009.03958.x

Cited by 150 publications

(94 citation statements)

References 29 publications

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“…They compared between rifaximin and ciprofloxacin. [25] It was a four-week follow-up study, in which they reported a significantly lower rate of SBP in patients treated with systemic antibiotic prophylaxis (n =17), while SBP rates in patients with no prophylactic treatment (n= 108) and in patients taking rifaximin (n= 27) were comparable. On the other hand, few studies have investigated rifaximin versus placebo for SBP prophylaxis in cirrhotics.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy of Rifaximin and Norfloxacin in Prevention of Spontaneous Bacterial Peritonitis

Narang¹,

Pandav²,

Vyas³

et al. 2018

AIMDR

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Background: Norfloxacin is the most commonly used agent for the prophylaxis against spontaneous bacterial peritonitis (SBP) in patients with liver cirrhosis. Rifaximin, another broad spectrum antibiotic, is used for the treatment of traveler's diarrhea and hepatic encephalopathy. Objective: We aimed to test the efficacy of rifaximin versus norfloxacin for prevention of SBP in patients with hepatitis C virus (HCV)-related liver cirrhosis. Methods: 100 patients with HCV-related liver cirrhosis and ascites were included in study and divided into two groups of matching age, sex and Child-Pugh class. Group I patients were given norfloxacin 400 mg/day and group II patients were given total dose of rifaximin 1200 mg/day in three divided doses. The follow up time was one year. Results: Patients on rifaximin developed fewer episodes of SBP than those on norfloxacin (8% vs 16% respectively) although it was statistically insignificant (p=0.265). Also, the duration before developing a new attack of SBP was longer in patients treated with rifaximin as compared to those taking norfloxacin (9.0 vs. 5.5 months, respectively). Additionally, rifaximin significantly reduced the rate of new compared to past episodes of SBP by 24% (p while the rate reduction with norfloxacin was only by 18% and not statistically significant (p= 0.45). Overall survival was equal in both groups. Conclusion: Rifaximin is -at least -as good as norfloxacin. It seems to be an appropriate alternative for long-term primary and secondary prophylaxis of SBP in cirrhotic patients with ascites.

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Section: Discussionmentioning

confidence: 99%

Comparison of Efficacy of Rifaximin and Norfloxacin in Prevention of Spontaneous Bacterial Peritonitis

Narang¹,

Pandav²,

Vyas³

et al. 2018

AIMDR

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“…Although rifaximin has not been extensively investigated with appropriate duration for its full anti-fibrotic effect, a previous study has shown a decrease in hepatic venous pressure gradient in patients with alcohol-related decompensated cirrhosis after 4 weeks of rifaximin administration. 19 Therefore, studies for long-term treatment of rifaximin-greater than 4 weeks in duration-are warranted.…”

Section: Discussionmentioning

confidence: 99%

Effect of Rifaximin on Hepatic Fibrosis in Bile Duct-ligated Rat Model

Shin

Kwon

Lee

et al. 2017

Korean J Gastroenterol

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Background/Aims: The translocation of bacteria and their lipopolysaccharides from the gut can promote fibrosis in cirrhotic patients. The aim of this study was to investigate the effects of rifaximin on hepatic fibrosis in a bile duct-ligated rat model. Methods: The bile duct ligation (BDL) was carried out for eight days (acute injury model: sham-operated rats [G1], BDL rats [G2], and BDL rats treated with rifaximin [G3]) or 22 days (chronic injury model: sham-operated rats [G4], BDL rats [G5], and BDL rats treated with rifaximin [G6]). Rifaximin (50 mg/kg/day) was administered daily via gavage after BDL. Liver function, serum tumor necrosis factor-alpha (TNF-α), and hepatic hydroxyproline levels were measured. Moreover, a histological analysis of fibrosis contents was performed using sirius red stain. Results: In the acute injury model, the liver function and TNF-α level were not improved after the rifaximin treatment. The hydroxyproline levels (μg/g liver tissue) in G1, G2, and G3 were 236.4±103.1, 444.8±114.4, and 312.5±131.6, respectively; and fibrosis contents (%) were 0.22±0.04, 1.64±0.53, and 1.66±0.44, respectively. The rifaximin treatment did not ameliorate acute BDL-induced fibrosis. In the chronic injury model, the hydroxyproline levels in G4, G5, and G6 were 311.5±72.9, 1,110.3±357.9, and 944.3±209.3, respectively; and fibrosis contents (%) were 0.19±0.03, 5.04±0.18, and 4.42±0.68, respectively (G5 vs. G6, p=0.059). The rifaximin treatment marginally ameliorated chronic BDL-induced fibrosis. Recently, it has been suggested that there is a significant relationship between gut microbiome and liver disease.Given that the liver is the first extraintestinal organ that encounters venous blood from the small and large intestines via 신승각 등. 간섬유화와 리팍시민The Korean Journal of Gastroenterology Therefore, in this study, we investigated the effects of rifaximin on hepatic inflammation and fibrosis in a bile duct-ligated rat model of acute and chronic liver injury. SUBJECTS AND METHODS Materials and animal experimentsRifaximin was provided by Hanall Biopharma (Seoul, Korea Bile duct ligationFor all surgical procedures, the rats were anesthetized by inhalation of 5 vol% isoflurane in 100% oxygen at a flow rate of 4 L/min for the induction and 2-3 vol% at 2 L/min for the maintenance. In the sham operated group, a midline incision in the abdomen was made using the sterile techniques. In the BDL and BDL-rifaximin groups, after a midline laparotomy of 1-2 cm, the common bile duct was identified, doubly ligated using 5-0 silk sutures, and transected at the level of 0.7-0.8 cm distal to the last bifurcation. The first ligature was made below the junction of the hepatic ducts, and the second ligature was made above the entrance to the pancreatic ducts. Finally, the common bile duct was resected between the double ligatures. Each animal received a subcutaneous injection of 10 mg/kg ketoprofen for 1 day and 5 mg/kg gentamicin for 3 days, after the surgery. Rats in the sham G1, BDL G2, and BDL-rifaximin G3 groups were sacrif...

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“…Intestinal decontamination with rifaximin has also shown increased liver hemodynamics and decreased incidence of hepatic encephalopathy in patients with alcoholic liver disease (ALD) [24,25] . The second component of alcohol induced endotoxemia is increased gut permeability.…”

Section: Inalcoholic Hepatitismentioning

confidence: 99%

Alcoholic hepatitis: The pivotal role of Kupffer cells

Suraweera

Weeratunga

et al. 2015

WJGP

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Kupffer cells play a central role in the pathogenesis of alcoholic hepatitis (AH). It is believed that alcohol increases the gut permeability that results in raised levels of serum endotoxins containing lipopolysaccharides (LPS). LPS binds to LPS-binding proteins and presents it to a membrane glycoprotein called CD14, which then activates Kupffer cells via a receptor called tolllike receptor 4. This endotoxin mediated activation of Kupffer cells plays an important role in the inflammatory process resulting in alcoholic hepatitis. There is no effective treatment for AH, although notable progress has been made over the last decade in understanding the underlying mechanism of alcoholic hepatitis. We specifically review the current research on the role of Kupffer cells in the pathogenesis of AH and the treatment strategies. We suggest that the imbalance between the pro-inflammatory and the anti-inflammatory process as well as the increased production of reactive oxygen species eventually lead to hepatocyte injury, the final event of alcoholic hepatitis.

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Intestinal decontamination improves liver haemodynamics in patients with alcohol‐related decompensated cirrhosis

Abstract: SUMMARY BackgroundEndotoxaemia is commonly seen in cirrhotic patients with ascites and this may be associated with increased portal pressure.

Cited by 150 publications

References 29 publications

Comparison of Efficacy of Rifaximin and Norfloxacin in Prevention of Spontaneous Bacterial Peritonitis

Comparison of Efficacy of Rifaximin and Norfloxacin in Prevention of Spontaneous Bacterial Peritonitis

Effect of Rifaximin on Hepatic Fibrosis in Bile Duct-ligated Rat Model

Alcoholic hepatitis: The pivotal role of Kupffer cells

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