Rifaximin for the treatment of diarrhea-predominant irritable bowel syndrome

Kane, John S; Ford, Alexander C

doi:10.1586/17474124.2016.1140571

Cited by 28 publications

(14 citation statements)

References 80 publications

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“…Moreover, SIBO‐related symptoms were common in IBS such as abdominal discomfort, bloating, and flatulence . Treatment‐presumed SIBO with antibiotics, such as rifaximin, has been shown to improve IBS symptoms in at least 40% of subjects . It further supports the potential roles of SIBO in IBS and may predict a response to antibiotics in these patients …”

Section: Introductionmentioning

confidence: 69%

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Yang

Zhang

Hong

et al. 2019

J of Gastro and Hepatol

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Key wordsglucose hydrogen breath test, irritable bowel syndrome, microbial dysbiosis index, mucosalassociated microbiota, small intestinal bacterial overgrowth. AbstractBackground and Aim: Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome, particularly the diarrhea-predominant subtype (IBS-D). We aimed to identify potential intestinal microbial pattern in IBS-D patients with SIBO. Methods: Diarrhea-predominant irritable bowel syndrome patients fulfilling Rome III criteria were recruited and randomly divided into an exploratory cohort (57 cases) and a validation cohort (20 cases). SIBO was identified according to standard glucose hydrogen breath test. For 16S rRNA gene sequencing, samples of duodenal mucosa, duodenal fluid, rectal mucosa, and fresh feces were collected and performed. The α and β diversity, as well as differences in microbial composition and function, in SIBO + and SIBO À IBS-D subjects were evaluated. Results: The microbial diversity and composition obviously differed between SIBO + and SIBO À IBS-D in duodenal and rectal mucosa but not in duodenal fluid and fresh feces. For rectal mucosal microbiota, it displayed markedly reduced aerobe and Gram-negative bacteria and increased facultative anaerobe and Gram-positive bacteria, moreover, altered functions of microbial metabolism in SIBO + IBS-D. Significantly higher rectal mucosarelated microbial dysbiosis index was observed in SIBO + IBS-D, and a cut-off value at À0.37 had a sensitivity of 56.55% and specificity of 90.91% to identify the SIBO in IBS-D subjects. Conclusions: Mucosal microbiota, rather than luminal bacteria, has a more apparent dysbiosis in SIBO + IBS-D patients relative to those without SIBO. Rectal mucosaassociated microbiota may act as a potential predictor of SIBO in IBS-D patients.

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Section: Introductionmentioning

confidence: 69%

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Yang

Zhang

Hong

et al. 2019

J of Gastro and Hepatol

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“…Alosetron and ramosetron are both antagonists of the 5-hydroxytryptamine-3 (5-HT 3 ) receptor, an action that may serve to slow gastrointestinal transit, alter rectal compliance12 13 and reduce visceral sensitivity 14. Rifaximin is a minimally absorbed broad-spectrum antibiotic that has been tested in IBS-D and IBS-M, on the basis that alterations in gastrointestinal microbiota may, in part, be responsible for symptoms 15. Finally, eluxadoline is a peripherally acting mixed µ-opioid and κ-opioid receptor agonist, and δ-opioid receptor antagonist, with minimal oral bioavailability, which reduces visceral hypersensitivity and slows gastrointestinal transit 16…”

Section: Introductionmentioning

confidence: 99%

Efficacy of pharmacological therapies in patients with IBS with diarrhoea or mixed stool pattern: systematic review and network meta-analysis

Black

Burr

Camilleri

et al. 2019

Gut

Self Cite

129

130

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ObjectiveOver half of patients with IBS have either diarrhoea (IBS-D) or a mixed stool pattern (IBS-M). The relative efficacy of licenced pharmacological therapies is unclear in the absence of head-to-head trials. We conducted a network meta-analysis to resolve this uncertainty.DesignWe searched MEDLINE, Embase, Embase Classic, the Cochrane central register of controlled trials, and Clinicaltrials.gov through January 2019 to identify randomised controlled trials (RCTs) assessing the efficacy of licenced pharmacological therapies (alosetron, eluxadoline, ramosetron and rifaximin) in adults with IBS-D or IBS-M. Trials included in the analysis reported a dichotomous assessment of overall response to therapy, and data were pooled using a random effects model. Efficacy and safety of all pharmacological therapies were reported as a pooled relative risk with 95% CIs to summarise the effect of each comparison tested. Treatments were ranked according to their p score.ResultsWe identified 18 eligible RCTs (seven alosetron, five ramosetron, two rifaximin and four eluxadoline), containing 9844 patients. All were superior to placebo for the treatment of IBS-D or IBS-M at 12 weeks, according to the Food and Drug Administration (FDA)-recommended endpoint for trials in IBS. Alosetron 1 mg twice daily was ranked first for efficacy, based on the FDA-recommended composite endpoint of improvement in both abdominal pain and stool consistency, effect on global symptoms of IBS and effect on stool consistency. Ramosetron 2.5µg once daily was ranked first for effect on abdominal pain. Total numbers of adverse events were significantly greater with alosetron 1 mg twice daily and ramosetron 2.5µg once daily, compared with placebo. Rifaximin 550 mg three times daily ranked first for safety. Constipation was significantly more common with all drugs, except rifaximin 550 mg three times daily.ConclusionIn a network meta-analysis of RCTs of pharmacological therapies for IBS-D and IBS-M, we found all drugs to be superior to placebo, but alosetron and ramosetron appeared to be the most effective.

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“…69 The detection of unchanged drug in stool samples following oral administration indicates that rifaximin has high availability in the GI tract, considered to be a factor in the minimum inhibitory concentrations observed against human GI bacteria (Table 1). 68,[70][71][72][73]…”

Section: Pharmacologymentioning

confidence: 99%

Mechanism of action and therapeutic benefit of rifaximin in patients with irritable bowel syndrome: a narrative review

Chey

Shah

DuPont

2020

Therap Adv Gastroenterol

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Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a multifactorial pathophysiology. The gut microbiota differs between patients with IBS and healthy individuals. After a bout of acute gastroenteritis, postinfection IBS may result in up to approximately 10% of those affected. Small intestinal bacterial overgrowth (SIBO) is more common in patients with IBS than in healthy individuals, and eradication of SIBO with systemic antibiotics has decreased symptoms of IBS in some patients with IBS and SIBO. The nonsystemic (i.e. low oral bioavailability) antibiotic rifaximin is indicated in the United States and Canada for the treatment of adults with IBS with diarrhea (IBS-D). The efficacy and safety of 2-week single and repeat courses of rifaximin have been demonstrated in randomized, placebo-controlled studies of adults with IBS. Rifaximin is widely thought to exert its beneficial clinical effects in IBS-D through manipulation of the gut microbiota. However, current studies indicate that rifaximin induces only modest effects on the gut microbiota of patients with IBS-D, suggesting that the efficacy of rifaximin may involve other mechanisms. Indeed, preclinical data reveal a potential role for rifaximin in the modulation of inflammatory cytokines and intestinal permeability, but these two findings have not yet been examined in the context of clinical studies. The mechanism of action of rifaximin in IBS is likely multifactorial, and further study is needed.

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Rifaximin for the treatment of diarrhea-predominant irritable bowel syndrome

Cited by 28 publications

References 80 publications

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Efficacy of pharmacological therapies in patients with IBS with diarrhoea or mixed stool pattern: systematic review and network meta-analysis

Mechanism of action and therapeutic benefit of rifaximin in patients with irritable bowel syndrome: a narrative review

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