Rifaximn in Irritable Bowel Syndrome.docVIP

Rifaximin in Irritable Bowel Syndrome Rationale, Evidence and Clinical Use Mohammed Saadi, MD, Richard W. McCallum, MD, FACP, FRACP, FACG Ther Adv Chronic Dis.?2013;4(2):71-75.? Abstract and Introduction Abstract Irritable bowel syndrome (IBS) is the most common functional bowel disease that affects up to 15% of the US population. The majority of patients with IBS have significant bloating and gas. Recent evidence is beginning to suggest that patients with IBS may have an alteration in the gastrointestinal flora. Specifically, findings suggest that patients with IBS have excessive bacteria in the small bowel, referred to as bacterial overgrowth. Therefore there may be benefits of antibiotic-based therapies for IBS. Rifaximin is a nonabsorbable antibiotic that demonstrates no clinically relevant bacterial resistance. Some studies have demonstrated the efficacy and durable improvement of IBS symptoms after treatment with rifaximin. In this review we explore the current data showing the association of small intestinal bacterial overgrowth (SIBO) and IBS as well as review the available data on the clinical use of rifaximin in the treatment of SIBO in patients with IBS. Introduction The complex communities of microorganisms that colonize the human gastrointestinal tract play an important role in human health. The development of culture-independent molecular techniques has provided new insights in the composition and diversity of the intestinal microbiota. There are up to a trillion microbes per milliliter of luminal contents in the distal gut [Levitt, 1969]. Our relationship with colonizing gut microbes begins at birth. The specific constitution of this microbiome varies between individuals and between the various regions of the gastrointestinal tract [Kim and Lin, 2007]. Evidence confirms that the human host and biology of gut bacteria are inseparable, so what happens if the relationship between the human host and gut microbiota is disturbed? Recent evidence suggests th