Efficacy and safety of rifaximin in the treatment of irritable bowel syndrome: a meta-analysis_West China Medical Journal

Authors：

HAN Wei ,  ZHANG Zhe , ZHOU Jinchi , WEI Yan , QIN Xiaojin , ZHAO Li , ZHAO Shuguang

Department of Gastroenterology, Tangdu Hospital, Air Force Medical University, Xi’an, Shaanxi 710038, P. R. China;

Corresponding author：

ZHANG Zhe, Email: 543337027@qq.com

Keywords：

Rifaximin; irritable bowel syndrome; abdominal pain; abdominal distention; adverse reactions; meta-analysis

DOI：

10.7507/1002-0179.202006070

Video：

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Objective To evaluate the efficacy and safety of rifaximin in the treatment of irritable bowel syndrome (IBS). Methods The computer system was used to retrieve PubMed, Embase, Web of Science, Cochrane Library, SinoMed, China National Knowledge Infrastructure, Wanfang and Chongqing VIP databases, and the randomized controlled trials of rifaximin for IBS published before November 30, 2022 were retrieved. The data were meta-analysed using RevMan 5.1 and Stata 12.0 softwares. Results Finally, 8 studies including 5176 patients were included. Meta-analysis results showed that the overall effective rate [relative risk (RR)=1.40, 95% confidence interval (CI) (1.21, 1.62), P<0.00001], abdominal pain relief rate [RR=1.21, 95%CI (1.12, 1.32), P<0.00001], abdominal distension relief rate [RR=1.28, 95%CI (1.15, 1.41), P<0.00001], and stool character improvement rate [RR=1.20, 95%CI (1.10, 1.32), P<0.0001] of rifaximin in the treatment of IBS were better than those of the control group. There was no significant difference in the incidence of adverse reactions (P>0.05). Conclusion Rifaximin can effectively improve the abdominal pain, abdominal distension and stool characteristics of IBS patients, and it is safe and reliable.

Citation： HAN Wei, ZHANG Zhe, ZHOU Jinchi, WEI Yan, QIN Xiaojin, ZHAO Li, ZHAO Shuguang. Efficacy and safety of rifaximin in the treatment of irritable bowel syndrome: a meta-analysis. West China Medical Journal, 2022, 37(12): 1843-1850. doi: 10.7507/1002-0179.202006070 Copy

1.	Sebastián Domingo JJ. Irritable bowel syndrome. Med Clin (Barc), 2022, 158(2): 76-81.
2.	Nelson AD, Black CJ, Houghton LA, et al. Systematic review and network meta-analysis: efficacy of licensed drugs for abdominal bloating in irritable bowel syndrome with constipation. Aliment Pharmacol Ther, 2021, 54(2): 98-108.
3.	Dale HF, Lied GA. Gut microbiota and therapeutic approaches for dysbiosis in irritable bowel syndrome: recent developments and future perspectives. Turk J Med Sci, 2020, 50(SI-2): 1632-1641.
4.	Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology, 2021, 160(1): 99-114.e3.
5.	Cangemi DJ, Lacy BE. Management of irritable bowel syndrome with diarrhea: a review of nonpharmacological and pharmacological interventions. Therap Adv Gastroenterol, 2019, 12: 1756284819878950.
6.	Chey WD, Shah ED, DuPont HL. Mechanism of action and therapeutic benefit of rifaximin in patients with irritable bowel syndrome: a narrative review. Therap Adv Gastroenterol, 2020, 13: 1756284819897531.
7.	Li J, Zhu W, Liu W, et al. Rifaximin for irritable bowel syndrome: a meta-analysis of randomized placebo-controlled trials. Medicine (Baltimore), 2016, 95(4): e2534.
8.	杨光, 赵施竹, 赵正焱. 利福昔明治疗肠道易激综合征的临床观察. 中华全科医学, 2013, 11(3): 423, 487.
9.	王晓辉, 闫志辉, 李超, 等. 双歧杆菌三联活菌胶囊与利福昔明治疗肠易激综合征合并小肠细菌过度生长临床效果比较. 解放军医学院学报, 2015(10): 970-972, 975.
10.	Sharara AI, Aoun E, Abdul-Baki H, et al. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol, 2006, 101(2): 326-333.
11.	Pimentel M, Park S, Mirocha J, et al. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med, 2006, 145(8): 557-563.
12.	Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med, 2011, 364(1): 22-32.
13.	Lembo A, Pimentel M, Rao SS, et al. Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology, 2016, 151(6): 1113-1121.
14.	Schoenfeld P, Pimentel M, Chang L, et al. Safety and tolerability of rifaximin for the treatment of irritable bowel syndrome without constipation: a pooled analysis of randomised, double-blind, placebo-controlled trials. Aliment Pharmacol Ther, 2014, 39(10): 1161-1168.
15.	Lembo A, Rao SSC, Heimanson Z, et al. Abdominal pain response to rifaximin in patients with irritable bowel syndrome with diarrhea. Clin Transl Gastroenterol, 2020, 11(3): e00144.
16.	Pimentel M, Lembo A. Microbiome and its role in irritable bowel syndrome. Dig Dis Sci, 2020, 65(3): 829-839.
17.	Kim JH, Jee SR. Irritable bowel syndrome. Korean J Gastroenterol, 2019, 73(2): 84-91.
18.	Zhuang X, Tian Z, Li L, et al. Fecal microbiota alterations associated with diarrhea-predominant irritable bowel syndrome. Front Microbiol, 2018, 9: 1600.
19.	何佳璨, 周桂荣, 李欣欣, 等. 肠道菌群与肠易激综合征相关研究进展. 中国微生态学杂志, 2020, 32(1): 117-124.
20.	杜海涛, 陈峥, 万军. 肠易激综合征的病理机制研究进展. 解放军医学院学报, 2017, 38(1): 85-88.
21.	Bajaj JS, Barbara G, DuPont HL, et al. New concepts on intestinal microbiota and the role of the non-absorbable antibiotics with special reference to rifaximin in digestive diseases. Dig Liver Dis, 2018, 50(8): 741-749.
22.	DuPont HL. Review article: the antimicrobial effects of rifaximin on the gut microbiota. Aliment Pharmacol Ther, 2016, 43(Suppl 1): 3-10.
23.	Lairani F, Errami AA, Oubaha S, et al. Rifaximin in the management of irritable bowel syndrome. J Gastroenterol Hepatol, 2021, 36: 251.
24.	Cash BD, Pimentel M, Rao SSC, et al. Repeat treatment with rifaximin improves irritable bowel syndrome-related quality of life: a secondary analysis of a randomized, double-blind, placebo-controlled trial. Therap Adv Gastroenterol, 2017, 10(9): 689-699.
25.	郑鋆, 吴盛迪, 董玲, 等. 利福昔明联合肠菌移植治疗腹泻型肠易激综合征的临床疗效及安全性. 中国临床医学, 2019, 26(2): 229-233.
26.	Ford AC, Harris LA, Lacy BE, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther, 2018, 48(10): 1044-1060.
27.	崔国艳, 丁境文, 刘正江, 等. 利福昔明对腹泻型肠易激综合征大鼠肠道菌群的影响. 长治医学院学报, 2020, 34(1): 28-30, 60.
28.	韩伟, 赵丽, 周金池, 等. 利福昔明在胃肠道疾病中的应用现状. 胃肠病学和肝病学杂志, 2020, 29(4): 466-468, 473.
29.	Ghoshal UC, Srivastava D, Misra A. A randomized double-blind placebo-controlled trial showing rifaximin to improve constipation by reducing methane production and accelerating colon transit: a pilot study. Indian J Gastroenterol, 2018, 37(5): 416-423.
30.	Bruzzese E, Pesce M, Sarnelli G, et al. Pharmacokinetic drug evaluation of rifaximin for treatment of diarrhea-predominant irritable bowel syndrome. Expert Opin Drug Metab Toxicol, 2018, 14(7): 753-760.
31.	Menees SB, Maneerattannaporn M, Kim HM, et al. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol, 2012, 107(1): 28-36.

1. Sebastián Domingo JJ. Irritable bowel syndrome. Med Clin (Barc), 2022, 158(2): 76-81.
2. Nelson AD, Black CJ, Houghton LA, et al. Systematic review and network meta-analysis: efficacy of licensed drugs for abdominal bloating in irritable bowel syndrome with constipation. Aliment Pharmacol Ther, 2021, 54(2): 98-108.
3. Dale HF, Lied GA. Gut microbiota and therapeutic approaches for dysbiosis in irritable bowel syndrome: recent developments and future perspectives. Turk J Med Sci, 2020, 50(SI-2): 1632-1641.
4. Sperber AD, Bangdiwala SI, Drossman DA, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of rome foundation global study. Gastroenterology, 2021, 160(1): 99-114.e3.
5. Cangemi DJ, Lacy BE. Management of irritable bowel syndrome with diarrhea: a review of nonpharmacological and pharmacological interventions. Therap Adv Gastroenterol, 2019, 12: 1756284819878950.
6. Chey WD, Shah ED, DuPont HL. Mechanism of action and therapeutic benefit of rifaximin in patients with irritable bowel syndrome: a narrative review. Therap Adv Gastroenterol, 2020, 13: 1756284819897531.
7. Li J, Zhu W, Liu W, et al. Rifaximin for irritable bowel syndrome: a meta-analysis of randomized placebo-controlled trials. Medicine (Baltimore), 2016, 95(4): e2534.
8. 杨光, 赵施竹, 赵正焱. 利福昔明治疗肠道易激综合征的临床观察. 中华全科医学, 2013, 11(3): 423, 487.
9. 王晓辉, 闫志辉, 李超, 等. 双歧杆菌三联活菌胶囊与利福昔明治疗肠易激综合征合并小肠细菌过度生长临床效果比较. 解放军医学院学报, 2015(10): 970-972, 975.
10. Sharara AI, Aoun E, Abdul-Baki H, et al. A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence. Am J Gastroenterol, 2006, 101(2): 326-333.
11. Pimentel M, Park S, Mirocha J, et al. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med, 2006, 145(8): 557-563.
12. Pimentel M, Lembo A, Chey WD, et al. Rifaximin therapy for patients with irritable bowel syndrome without constipation. N Engl J Med, 2011, 364(1): 22-32.
13. Lembo A, Pimentel M, Rao SS, et al. Repeat treatment with rifaximin is safe and effective in patients with diarrhea-predominant irritable bowel syndrome. Gastroenterology, 2016, 151(6): 1113-1121.
14. Schoenfeld P, Pimentel M, Chang L, et al. Safety and tolerability of rifaximin for the treatment of irritable bowel syndrome without constipation: a pooled analysis of randomised, double-blind, placebo-controlled trials. Aliment Pharmacol Ther, 2014, 39(10): 1161-1168.
15. Lembo A, Rao SSC, Heimanson Z, et al. Abdominal pain response to rifaximin in patients with irritable bowel syndrome with diarrhea. Clin Transl Gastroenterol, 2020, 11(3): e00144.
16. Pimentel M, Lembo A. Microbiome and its role in irritable bowel syndrome. Dig Dis Sci, 2020, 65(3): 829-839.
17. Kim JH, Jee SR. Irritable bowel syndrome. Korean J Gastroenterol, 2019, 73(2): 84-91.
18. Zhuang X, Tian Z, Li L, et al. Fecal microbiota alterations associated with diarrhea-predominant irritable bowel syndrome. Front Microbiol, 2018, 9: 1600.
19. 何佳璨, 周桂荣, 李欣欣, 等. 肠道菌群与肠易激综合征相关研究进展. 中国微生态学杂志, 2020, 32(1): 117-124.
20. 杜海涛, 陈峥, 万军. 肠易激综合征的病理机制研究进展. 解放军医学院学报, 2017, 38(1): 85-88.
21. Bajaj JS, Barbara G, DuPont HL, et al. New concepts on intestinal microbiota and the role of the non-absorbable antibiotics with special reference to rifaximin in digestive diseases. Dig Liver Dis, 2018, 50(8): 741-749.
22. DuPont HL. Review article: the antimicrobial effects of rifaximin on the gut microbiota. Aliment Pharmacol Ther, 2016, 43(Suppl 1): 3-10.
23. Lairani F, Errami AA, Oubaha S, et al. Rifaximin in the management of irritable bowel syndrome. J Gastroenterol Hepatol, 2021, 36: 251.
24. Cash BD, Pimentel M, Rao SSC, et al. Repeat treatment with rifaximin improves irritable bowel syndrome-related quality of life: a secondary analysis of a randomized, double-blind, placebo-controlled trial. Therap Adv Gastroenterol, 2017, 10(9): 689-699.
25. 郑鋆, 吴盛迪, 董玲, 等. 利福昔明联合肠菌移植治疗腹泻型肠易激综合征的临床疗效及安全性. 中国临床医学, 2019, 26(2): 229-233.
26. Ford AC, Harris LA, Lacy BE, et al. Systematic review with meta-analysis: the efficacy of prebiotics, probiotics, synbiotics and antibiotics in irritable bowel syndrome. Aliment Pharmacol Ther, 2018, 48(10): 1044-1060.
27. 崔国艳, 丁境文, 刘正江, 等. 利福昔明对腹泻型肠易激综合征大鼠肠道菌群的影响. 长治医学院学报, 2020, 34(1): 28-30, 60.
28. 韩伟, 赵丽, 周金池, 等. 利福昔明在胃肠道疾病中的应用现状. 胃肠病学和肝病学杂志, 2020, 29(4): 466-468, 473.
29. Ghoshal UC, Srivastava D, Misra A. A randomized double-blind placebo-controlled trial showing rifaximin to improve constipation by reducing methane production and accelerating colon transit: a pilot study. Indian J Gastroenterol, 2018, 37(5): 416-423.
30. Bruzzese E, Pesce M, Sarnelli G, et al. Pharmacokinetic drug evaluation of rifaximin for treatment of diarrhea-predominant irritable bowel syndrome. Expert Opin Drug Metab Toxicol, 2018, 14(7): 753-760.
31. Menees SB, Maneerattannaporn M, Kim HM, et al. The efficacy and safety of rifaximin for the irritable bowel syndrome: a systematic review and meta-analysis. Am J Gastroenterol, 2012, 107(1): 28-36.

West China Medical Journal

Efficacy and safety of rifaximin in the treatment of irritable bowel syndrome: a meta-analysis

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