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Dumitrascu DL, Bakulin I, Berzigotti A, Cravo M, Gombošová L, Lukas M, Pietrzak A, Remes-Troche JM, Romero-Gómez M, Balmori MA, Gonçalves TC, Hamzaoui L, Juricek R, Moreira L, Neubauer K, Surdea-Blaga T, Tikhonov IN, Trna J, Ianiro G, Ponziani FR, Gasbarrini A. Update on the Role of Rifaximin in Digestive Diseases. JGLD 2023; 32:92-109. [PMID: 37004222 DOI: 10.15403/jgld-4871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023]
Abstract
Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug.
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Affiliation(s)
- Dan Lucian Dumitrascu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj County Clinical Emergency Hospital, Cluj-Napoca, Romania.
| | - Igor Bakulin
- Mechnikov North-Western State Medical University, Saint Petersburg, Russia.
| | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
| | - Marília Cravo
- Serviço de gastrenterologia hospital da luz Lisboa and faculdade de medicina da universidade de Lisboa. Lisbon, Portugal.
| | - Laura Gombošová
- II Internal Clinic, University Hospital of L. Pasteur and Medical faculty of P.J.Šafarik University, Košice, Slovakia.
| | - Milan Lukas
- Clinical and Research Centre for Inflammatory Bowel Diseases, ISCARE IVF Clinical Center Českomoravská, Prague, Czech Republic.
| | - Anna Pietrzak
- II Gastroenterology Department, Centre of Postgraduate Medical Education, Warsaw; Gastroenterology Department, Bielanski Hospital, Warsaw, Poland.
| | | | - Manuel Romero-Gómez
- UCM Digestive Diseases and ciberehd. Virgen del Rocío University Hospital. Institute of Biomedicine of Seville (HUVRocío/CSIC/US). Department of Medicine. University of Seville, Seville Spain.
| | - Mercedes Amieva Balmori
- Laboratory of Digestive Physiology and Motility. Medical - Biological Research Institute of the Universidad Veracruzana, Veracruz, Mexico.
| | - Tiago Cúrdia Gonçalves
- Gastroenterology Department, Hospital da Senhora da Oliveira - Guimarães, Portugal and Life, Braga; Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga; ICVS/3B's, PT Government Associate Laboratory, Guimarães/Braga, Portugal.
| | - Lamine Hamzaoui
- Gastroenterology department. Mohamed Taher Maamouri Hospital, Nabeul; University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia.
| | - Radovan Juricek
- Department of Gastroenterology, Nemocnica Bory - Penta Hospitals, Bratislava, Slovakia.
| | - Leticia Moreira
- Gastroenterology Department, Hospital Clinic of Barcelona, University of Barcelona, Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain.
| | - Katarzyna Neubauer
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland.
| | - Teodora Surdea-Blaga
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj County Clinical Emergency Hospital, Cluj-Napoca, Romania.
| | - Igor N Tikhonov
- Internal Diseases Propedeutics, Gastroenterology and Hepatology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia.
| | - Jan Trna
- Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno; Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
| | - Gianluca Ianiro
- CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Francesca Romana Ponziani
- CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome; Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Antonio Gasbarrini
- Università Cattolica del Sacro Cuore, Rome; Internal Medicine and Gastroenterology, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
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Salgado Alvarez GA, Pinto Galvez SM, Garcia Mora U, Cano Contreras AD, Durán Rosas C, Priego-Parra BA, Triana Romero A, Amieva Balmori M, Roesch Dietlen F, Martinez Vazquez SE, Mendez Guerrero IO, Chi-Cervera LA, Bernal Reyes R, Martinez Roriguez LA, Icaza Chavez ME, Remes Troche JM. Higher cardiovascular risk scores and liver fibrosis risk estimated by biomarkers in patients with metabolic-dysfunction-associated fatty liver disease. World J Hepatol 2022; 14:1633-1642. [PMID: 36157869 PMCID: PMC9453468 DOI: 10.4254/wjh.v14.i8.1633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/15/2022] [Accepted: 07/31/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The definition of metabolic-dysfunction-associated fatty liver disease (MAFLD) allows identification of metabolically complicated patients. Fibrosis risk scores are related to cardiovascular risk (CVR) scores and could be useful for the identification of patients at risk of systemic complications.
AIM To evaluate the relationship between MAFLD and CVR using the Framingham risk score in a group of Mexican patients.
METHODS Cross-sectional, observational and descriptive study carried out in a cohort of 585 volunteers in the state of Veracruz with MAFLD criteria. The risk of liver fibrosis was calculated with aspartate aminotransferase-to-platelet ratio index, nonalcoholic fatty liver disease score and fibrosis-4, as well as with transient hepatic elastography with Fibroscan®. The CVR was determined by the Framingham system.
RESULTS One hundred and twenty-five participants (21.4%) with MAFLD criteria were evaluated, average age 54.4 years, 63.2% were women, body mass index 32.3 kg/m2. The Framingham CVR was high in 43 patients (33.9%). Transient elastography was performed in 55.2% of volunteers; 39.1% with high CVR and predominance in advanced fibrosis (F3–F4). The logistic regression analysis showed that liver fibrosis, diabetes and hypertension independently increased CVR.
CONCLUSION One of every three patients with MAFLD had a high CVR, and in those with high fibrosis risk, the CVR risk was even greater.
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Affiliation(s)
| | | | - Uriel Garcia Mora
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Ana Delfina Cano Contreras
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Cristina Durán Rosas
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Bryan Adrián Priego-Parra
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Arturo Triana Romero
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Mercedes Amieva Balmori
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Federico Roesch Dietlen
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
| | - Sophia Eugenia Martinez Vazquez
- Department of Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México 14080, México, Mexico
| | - Ines Osvely Mendez Guerrero
- Department of Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México 14080, México, Mexico
| | - Luis Alberto Chi-Cervera
- Clínica de Especialidades Gastrointestinales y Hepáticas, Hospital Star Medica, Merida 97133, Yucatan, Mexico
| | - Raúl Bernal Reyes
- Department of Gastroenterologia, Sociedad Española de Beneficencia, Pachuca 42000, Hidalgo, Mexico
| | | | | | - Jose Maria Remes Troche
- Instituto de Investigaciones Médico-biologicas, Universidad Veracruzana, Veracruz 91700, Veracruz, Mexico
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Cano-Contreras AD, Minero Alfaro IJ, Medina López VM, Amieva Balmori M, Remes Troche JM, Espadaler Mazo J, Perez Lopez N. Efficacy of i3.1 Probiotic on Improvement of Lactose Intolerance Symptoms: A Randomized, Placebo-controlled Clinical Trial. J Clin Gastroenterol 2022; 56:141-147. [PMID: 33136781 DOI: 10.1097/mcg.0000000000001456] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/24/2020] [Indexed: 12/10/2022]
Abstract
GOAL The aim of this study was to assess the efficacy of probiotic i3.1 in improving lactose intolerance symptoms compared with placebo after 8 weeks of treatment. BACKGROUND Probiotics are promising strategies to prevent and improve lactose intolerance symptoms, but previous studies have provided conflicting results. MATERIALS AND METHODS This randomized, prospective, placebo-controlled study was conducted at the Hospital Juárez de México. We recruited adult patients with lactose intolerance confirmed by a lactose hydrogen breath test (LHBT) ≥20 parts per million (ppm) and a lactose intolerance symptom score ≥6 both upon lactose challenge. We compared the change from baseline in the scores of a validated symptom questionnaire and the LHBT after 8 weeks of probiotic or placebo treatment. RESULTS We included 48 patients: 33 receiving the probiotic and 15 receiving placebo (2:1 randomization). Demographic characteristics were homogeneous between groups. The reduction in total symptom score after a lactose challenge was significantly higher in the probiotic group versus the placebo group (-5.11 vs. -1.00; P<0.001). All the subscores significantly decreased from baseline in the probiotic group, except for vomiting, with significant differences between the probiotic and placebo groups for abdominal pain (P=0.045) and flatulence (P=0.004). The area under the curve of the LHBT was significantly reduced from baseline in the probiotic group (P=0.019), but differences between groups were not significant (P=0.621). Adverse events were mild without differences between groups, and no serious adverse event was registered. CONCLUSION The i3.1 probiotic was safe and efficacious in reducing lactose intolerance symptoms in patients with lactose intolerance, but did not change the LHBT.
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Affiliation(s)
| | | | | | - Mercedes Amieva Balmori
- Digestive Physiology and Gastrointestinal Motility Laboratory, Medical-Biological Research Institute, Veracruzana University, Veracruz, Mexico
| | - José M Remes Troche
- Digestive Physiology and Gastrointestinal Motility Laboratory, Medical-Biological Research Institute, Veracruzana University, Veracruz, Mexico
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