Rational Use of Antibiotics in the Treatment of Functional Bowel Disorders 英文参考文献.docVIP

Pharmaceuticals 2010, 3, 2380-2386; doi:10.3390/ph3082380 OPEN ACCESS pharmaceuticals ISSN 1424-8247 /journal/pharmaceuticals Opinion Rational Use of Antibiotics in the Treatment of Functional Bowel Disorders Michele Di Stefano, Roberta Fasulo and Gino Roberto Corazza * Department of Medicine, University of Pavia, Foundation IRCCS S.Matteo Hospital, P.le C. Golgi 2, Pavia, Italy * Author to whom correspondence should be addressed; E-Mail: gr.corazza@smatteo.pv.it; Tel.: +39-0382-502973; Fax: +39-0382-502618. Received: 13 May 2010; in revised form: 8 July 2010 / Accepted: 13 July 2010 / Published: 26 July 2010 Abstract: Functional gastrointestinal symptoms such us bloating, fullness, flatulence, diarrhea, and constipation due to irritable bowel syndrome (IBS) were recently attributed to small bowel bacterial overgrowth, a condition depending on the presence of an increased number of bacteria in the small bowel. However, the methodology used to describe this association may be harshly criticized, since it has already been shown to be quite inaccurate. As a result an inappropriate use of antibiotics was consequently generated. In fact, antibiotics could be effective in the treatment of functional complaints, but only in a limited subgroup of patients, characterized by an increase of fermentation at colonic level. In this review, we have examined the papers suggesting a pathophysiological link between IBS and small bowel bacterial overgrowth, underlining its inappropriateness, and put forth our personal view on the rationale for antibiotic use in IBS. Keywords: small intestine bacterial overgrowth; functional bowel disorders; irritable bowel syndrome; rifaximin; gas-related symptoms 1. Introduction It has been estimated that functional bowel disorders are characterized by a high prevalence in the general population [1] and they represent a very frequent cause for gastroenterological out