Predicting a Response to Antibiotics in Patients with the Irritable Bowel Syndrome

Kasir, Rafid; Zakko, Salam; Zakko, Philip; Adler, Michaël; Lee, Aaron; Dhingra, Sachin; Guttermuth, Cecile F.

doi:10.1007/s10620-015-3872-9

Cited by 10 publications

(8 citation statements)

References 23 publications

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“…Moreover, SIBO‐related symptoms were common in IBS such as abdominal discomfort, bloating, and flatulence . Treatment‐presumed SIBO with antibiotics, such as rifaximin, has been shown to improve IBS symptoms in at least 40% of subjects . It further supports the potential roles of SIBO in IBS and may predict a response to antibiotics in these patients …”

Section: Introductionmentioning

confidence: 69%

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Yang

Zhang

Hong

et al. 2019

J of Gastro and Hepatol

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Key wordsglucose hydrogen breath test, irritable bowel syndrome, microbial dysbiosis index, mucosalassociated microbiota, small intestinal bacterial overgrowth. AbstractBackground and Aim: Small intestinal bacterial overgrowth (SIBO) has been proposed as an etiologic factor in irritable bowel syndrome, particularly the diarrhea-predominant subtype (IBS-D). We aimed to identify potential intestinal microbial pattern in IBS-D patients with SIBO. Methods: Diarrhea-predominant irritable bowel syndrome patients fulfilling Rome III criteria were recruited and randomly divided into an exploratory cohort (57 cases) and a validation cohort (20 cases). SIBO was identified according to standard glucose hydrogen breath test. For 16S rRNA gene sequencing, samples of duodenal mucosa, duodenal fluid, rectal mucosa, and fresh feces were collected and performed. The α and β diversity, as well as differences in microbial composition and function, in SIBO + and SIBO À IBS-D subjects were evaluated. Results: The microbial diversity and composition obviously differed between SIBO + and SIBO À IBS-D in duodenal and rectal mucosa but not in duodenal fluid and fresh feces. For rectal mucosal microbiota, it displayed markedly reduced aerobe and Gram-negative bacteria and increased facultative anaerobe and Gram-positive bacteria, moreover, altered functions of microbial metabolism in SIBO + IBS-D. Significantly higher rectal mucosarelated microbial dysbiosis index was observed in SIBO + IBS-D, and a cut-off value at À0.37 had a sensitivity of 56.55% and specificity of 90.91% to identify the SIBO in IBS-D subjects. Conclusions: Mucosal microbiota, rather than luminal bacteria, has a more apparent dysbiosis in SIBO + IBS-D patients relative to those without SIBO. Rectal mucosaassociated microbiota may act as a potential predictor of SIBO in IBS-D patients.

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Section: Introductionmentioning

confidence: 69%

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Yang

Zhang

Hong

et al. 2019

J of Gastro and Hepatol

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“…Therefore, the above findings should be interpreted with caution. Nevertheless, two recent studies 76,77 have shown that a positive H 2 BT does predict symptomatic response to antibiotic therapy in patients with IBS. A thoughtful Editorial 78 actually suggested that breath testing for SIBO could represent a mean to enrich rifaximin responders amongst IBS patients.…”

Section: Discussionmentioning

confidence: 99%

Systematic review with meta‐analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth

Gatta

Scarpignato

2017

Aliment Pharmacol Ther

190

131

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SummaryBackgroundSmall intestinal bacterial overgrowth (SIBO) is a heterogeneous syndrome, characterised by an increased number and/or abnormal type of bacteria in the small bowel. Over the past decades, rifaximin has gained popularity for this indication despite its use is not evidence based.AimTo perform a systematic review and meta‐analysis to summarise evidence about the efficacy and safety of rifaximin to eradicate SIBO in adult patients.Methods MEDLINE, EMBASE, CCRCT, Scopus and Web of Science were searched from inception to March 16, 2015 for RCTs and observational studies. Furthermore, abstract books of major European, American and Asian gastroenterological meetings were also examined.ResultsThirty‐two studies involving 1331 patients were included. The overall eradication rate according to intention‐to‐treat analysis was 70.8% (95% CI: 61.4–78.2; I 2 = 89.4%) and to per protocol analysis 72.9% (95% CI: 65.5–79.8; I 2 = 87.5%). Meta‐regression identified three covariates (drug dose, study design and co‐therapy) independently associated with an increased eradication rate. The overall rate of adverse events was 4.6% (95% CI: 2.3–7.5; I 2 = 63.6%). In the subset of studies (n= 10) allowing the analysis, improvement or resolution of symptoms in patients with eradicated SIBO was found to be 67.7% (95% CI: 44.7–86.9; I 2 = 91.3%).ConclusionsRifaximin treatment seems to be effective and safe for the treatment of SIBO. However, the quality of the available studies is generally poor. Well‐designed RCTs are needed to substantiate these findings and to establish the optimal regimen.

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“…It is possible that antibiotic therapy reduces the effects of methanogenic bacteria, given that patients with IBS, particularly IBS-C, were shown to have increased fecal concentrations of the methanogen Methanobrevibacter smithii compared with healthy individuals; further, methane producers by breath testing had greater concentrations of M. smithii [115]. However, a retrospective study of patients with IBS receiving antibiotic treatment reported that the best therapeutic response occurred in patients who had no increase in measured hydrogen and methane gases in a lactulose breath test [116]. Thus, while some evidence suggests that methanogenic bacteria may play a role in response to antibiotics, further study is needed.…”

Section: Antibioticsmentioning

confidence: 99%

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

Harris

Baffy

2017

Postgraduate Medicine

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Irritable bowel syndrome (IBS), which is characterized by recurrent abdominal pain and disordered bowel habits, is one of the most common functional bowel disorders. IBS is a substantial burden on both patient health-related quality of life and healthcare costs. Several pathophysiologic mechanisms have been postulated for the occurrence of IBS, including altered gastrointestinal motility, visceral hypersensitivity, changes in gut permeability, immune activation, gut-brain dysregulation, central nervous system dysfunction, and changes in the gut microbiota. Of note, both qualitative and quantitative differences have been observed in the gut microbiota of a population with IBS versus a healthy population. Because of the substantial interest in the gut microbiota and its role as a therapeutic target in IBS, this article provides an overview of specific interventions with the potential to modulate the gut microbiota in IBS, including elimination diets, prebiotics, probiotics, synbiotics, and nonsystemic antibiotics. Although probiotics and synbiotics are generally well tolerated, differences in the composition and concentration of different bacterial species and inclusion or exclusion of prebiotic components varies widely across studies and has prevented strong recommendations on their use in IBS. For nonsystemic antibiotics, rifaximin is indicated in the United States for the treatment of IBS with diarrhea in adults and has been shown to be efficacious and well tolerated in well-designed clinical trials. Overall, more consistent evidence is needed regarding the efficacy and safety of elimination diets, prebiotics, probiotics, and synbiotics for the treatment of patients with IBS. Furthermore, additional well-designed studies are needed that examine alterations in the gut microbiota that occur with these interventions and their potential associations with clinical symptoms of IBS. ARTICLE HISTORY

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Predicting a Response to Antibiotics in Patients with the Irritable Bowel Syndrome

Cited by 10 publications

References 23 publications

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Duodenal and rectal mucosal microbiota related to small intestinal bacterial overgrowth in diarrhea‐predominant irritable bowel syndrome

Systematic review with meta‐analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth

Modulation of the gut microbiota: a focus on treatments for irritable bowel syndrome

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