General practitioners' management of symptomatic uncomplicated diverticular disease of the colon by using rifaximin, a non-adsorbable antibiotic

OBJECTIVE

Symptomatic uncomplicated diverticular disease of the colon (SUDD) is generally managed by gastroenterologists rather than General Practitioners (GPs). The aim of this study was to assess the efficacy of the treatment of SUDD with rifaximin, a non-absorbable antibiotic, in a primary care setting by GPs.

PATIENTS AND METHODS

This retrospective, observational study investigated the use of rifaximin at a dose of 400 mg b.i.d. for 5, 7 or 10 days monthly, up to 3 months. The symptoms were reported by the patients using a visual analogic scale (VAS) of 0-10.

RESULTS

286 SUDD patients were enrolled (44.4% of men, average age 70.92±10.98). Respectively, 15 (5.2%) patients received the treatment for 5 days, 205 (71.7%) for 7 days and 66 (23.1%) for 10 days. After three months, a significant reduction of VAS score was observed in almost all symptoms assessed: 135 (47.2%) patients reported no abdominal pain (p<0.001) and 23 (8.1%) reported no symptom. Adverse events related to the treatment were recorded in 3 (1.04%) patients, all of them mild and not requiring interruption of the treatment. Acute diverticulitis occurred in 9 (3.1%) patients, but only 2 of them [0.7% (n=2)] underwent surgery due to complicated diverticulitis. Analysis within the different treatment groups (5, 7 and 10 days) shows that rifaximin treatment is effective in reducing the severity of symptoms in almost all groups except for the constipation in the 5-day group.

CONCLUSIONS

Rifaximin can be effectively used by GPs in real-life for the management of SUDD.

Effect of epomediol on taurocholate uptake in hepatocytes isolated from normal rats or rats with ethinyloestradiol-induced cholestasis

In this study the effect of epomediol (1,3,3-trimethyl-2-oxabicyclo 2.2.2 ocatan-6,7-endo, endo-diol) (Clesidren) on rat hepatocyte bile acid transport was evaluated using [3H]-taurocholate as a probe, in order to clarify the mechanism of action of this drug. To this purpose, primary cultures were prepared with hepatocytes obtained from normal rats (Group I), and rats receiving a 4-day treatment with either epomediol (100 mg/kg) (Group II), or ethinyloestradiol (5 mg/kg) (Group III), or ethinyloestradiol plus epomediol (5 mg and 100 mg/kg respectively) (Group IV) or vehicle DMSO 50 microliters/kg) (Group V). All hepatocytes were isolated 10 days after the end of treatment. Hepatocyte [3H]-taurocholate uptake was evaluated in vitro after 48 hr of incubation in the presence or absence of epomediol. In both cases no difference was found when evaluating the uptake of hepatocytes from Group I, II and V. In the absence of epomediol [3H]-taurocholate uptake in hepatocytes from rats of Group IV was significantly higher than that observed in hepatocytes from rats of Group III. On the other hand, the presence of epomediol did not influence [3H]-taurocholate uptake in hepatocytes from rats of Group III, which remained significantly lower compared to that of control hepatocytes (Group V). The protective effect obtained when administering epomediol simultaneously with ethinyloestradiol (Group IV) was not due to its ability to compete with ethynyloestradiol for the binding to oestrogen receptors. Our results indicate that epomediol is able to restore a normal hepatocyte bile acid uptake when given in vivo simultaneously with ethinyloestradiol but does not influence bile acid transport in cultured hepatocytes. Further studies are required to better define the choleretic activity of this drug.