Impact of rifaximin on cirrhosis complications and gastric microbiota in patients with gastroesophageal variceal bleeding: A pilot randomized controlled trial

IF 2.3 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Digestive Diseases Pub Date : 2024-10-23 DOI:10.1111/1751-2980.13314

Xiao Quan Huang, Ying Jie Ai, Feng Li, Si Tao Ye, Jia Hao Wang, Rui Zhang, Wei Zhang, Yu Li Zhu, Shi Yao Chen

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引用次数: 0

Abstract

Objectives

The application of rifaximin, a non-absorbable antibiotic, in hepatic encephalopathy (HE) has been well established; however, its effect on other complications in cirrhotic patients with previous gastroesophageal variceal bleeding (GEVB) remains unclear. Therefore, we performed a pilot randomized controlled trial aiming to evaluate the impact of rifaximin on cirrhosis-related complications and changes in gastric microbiota.

Methods

Eighty cirrhotic patients who received prophylactic endoscopic treatment for variceal rebleeding were randomly assigned to the control or rifaximin treatment group (rifaximin 400 mg twice daily for 8 weeks). Primary outcome was the total liver-related score, consisting of changes in cirrhosis-related complications including rebleeding, ascites, HE and portal vein thrombosis (PVT). The 16S rDNA sequencing analysis was conducted with gastric lavage fluid samples for the analysis of gastric microbiota.

Results

During the 8-week follow-up, the total liver-related score decreased significantly upon rifaximin therapy (−0.35 ± 0.14 vs 0.05 ± 0.14, p = 0.0465) as well as serum C-reactive protein (CRP) (p = 0.019) and interleukin-8 (p = 0.025) compared with the control group. The rate of PVT recanalization was significantly higher in the rifaximin group (p = 0.012). Prominent difference in gastric microbiota between the two groups was observed, and the rifaximin group had a higher abundance of several taxa which were dysregulated in the progression of cirrhosis. CRP was correlated with several taxa including Alphaproteobacteria, Rhizobiales and Collinsella.

Conclusions

Rifaximin may improve cirrhosis-related complications, including PVT, in patients with previous GEVB through anti-inflammatory and microbiota-modulating functions. Trial registration number: NCT02991612.

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利福昔明对胃食管静脉曲张出血患者肝硬化并发症和胃微生物群的影响：随机对照试验

目的：利福昔明是一种非吸收性抗生素，其在肝性脑病（HE）中的应用已得到证实；然而，它对曾有胃食管静脉曲张出血（GEVB）的肝硬化患者的其他并发症的影响仍不清楚。因此，我们进行了一项试点随机对照试验，旨在评估利福昔明对肝硬化相关并发症和胃微生物群变化的影响：80名因静脉曲张再出血而接受预防性内镜治疗的肝硬化患者被随机分配到对照组或利福昔明治疗组（利福昔明400毫克，每天两次，共8周）。主要结果是肝脏相关总分，包括再出血、腹水、肝硬化和门静脉血栓（PVT）等肝硬化相关并发症的变化。为分析胃微生物群，对洗胃液样本进行了 16S rDNA 测序分析：结果：在 8 周的随访中，与对照组相比，利福昔明治疗后肝脏相关总评分显著下降（-0.35 ± 0.14 vs 0.05 ± 0.14，p = 0.0465），血清 C 反应蛋白（CRP）（p = 0.019）和白细胞介素-8（p = 0.025）也显著下降。利福昔明组的 PVT 再闭合率明显更高（p = 0.012）。观察到两组患者的胃微生物群存在明显差异，利福昔明组的几个分类群丰度更高，而这些分类群在肝硬化进展过程中出现失调。CRP与几个分类群相关，包括Alphaproteobacteria、Rhizobiales和Collinsella：利福昔明可通过抗炎和微生物群调节功能改善既往有GEVB患者的肝硬化相关并发症，包括PVT：NCT02991612.

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Digestive Diseases 医学-胃肠肝病学

CiteScore

5.40

自引率

2.90%

发文量

审稿时长

6-12 weeks

期刊介绍： The Journal of Digestive Diseases is the official English-language journal of the Chinese Society of Gastroenterology. The journal is published twelve times per year and includes peer-reviewed original papers, review articles and commentaries concerned with research relating to the esophagus, stomach, small intestine, colon, liver, biliary tract and pancreas.