Rifaximin for the Management of Colonic Diverticular Disease: far Beyond a Simple Antibiotic

Tursi, Antonio; Scarpignato, Carmelo; Brandimarte, Giovanni; Mario, F. Di; Lanas, Fernando

doi:10.15403/jgld.2014.1121.274.rif

Cited by 9 publications

(4 citation statements)

References 45 publications

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“…It is hypothesized that the inflammation is not only limited to the mucosa, but also to the sub-mucosa. Since rifaximin works mainly in the lumen, restoring dysbiosis [13], and mesalazine works mainly in the mucosa by its activation to N-acetyl-5-ASA [14], both these drugs could be ineffective in controlling inflammation in DICA 2 and DICA 3 patients.…”

Section: Discussionmentioning

confidence: 99%

Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease

Tursi¹,

Cassieri²,

Colucci³

et al. 2020

JGLD

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Background and Aim: Although rifaximin and mesalazine seem to be effective in treating the majority of people suffering from diverticular disease (DD), some patients still experience symptoms following those treatments. The aim of this study was to assess the efficacy of budesonide MMXTM in managing symptoms and raised fecal calprotectin (FC) in patients with endoscopic diagnosis of DD and not responding to standard treatments. Methods: We performed a post-hoc analysis of the patients enrolled in the DICA prospective study. All patients were at the first diagnosis of DD, scored according to DICA classification. We assessed abdominal pain, meteorism, constipation and diarrhea (scored from 0 to 10) and FC expression at baseline and after six months. Patients were treated with budesonide MMXTM for 4 weeks (9 mg/day for 2 weeks, followed by 9 mg every other day for further 2 weeks), followed by mesalazine 2.4 grams/day for further 5 months. Results: We studied 24 patients (18 females and 6 males, median age 64, inter quartile range (IQR): 57.5- 73.5), previously treated with mesalazine and/or rifaximin (equally subdivided between DICA 2 and DICA 3). At 6-month follow-up, a significant reduction of all symptoms assessed was observed (abdominal pain and meteorism: p<0.001; constipation: p=0.007; diarrhea: p=0.009). Median (IQR) FC level was 244.5 (171.5- 322.0) μg/g at baseline and 51.0 (IQR: 35.5-61.5) μg/g (p< 0.001) after 6 months. No side effects were recorded. Conclusions: Treatment with budesonide MMXTM seems to be effective in obtaining symptoms’ control and dropping of FC in patients with DD and not responding to standard treatments.

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Section: Discussionmentioning

confidence: 99%

Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease

Tursi¹,

Cassieri²,

Colucci³

et al. 2020

JGLD

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“…91 Moreover, rifaximin has an eubiotic effect promoting the growth of beneficial anti-inflammatory bacteria such as Bifidobacteria, Lactobacilli, and Faecalibacterium prausnitzii, without impairing the overall gut microbiome and inducing a reduction in hydrogenproducing bacteria such as Ruminococcus, that may play a role in bloating symptoms. 19,[92][93][94][95] According to recent studies, rifaximin is supposed to have also a low-grade anti-inflammatory property thanks to its capacity of binding to the Pregnane X Receptor (PXR), a cytosolic protein that regulates inflammation and detoxification of xenobiotics, 96 as well as modulating the mucosal adaptive immune system. 97 In murine models of IBS, rifaximin improved visceral hyperalgesia by a microbiota-driven reduction in transient receptor potential vanilloid 1 channels expression (TRPV1, a receptor involved in pain perception) in the gut.…”

Section: Rifaximinmentioning

confidence: 99%

The role of microbiota and its modulation in colonic diverticular disease

Marasco

Buttitta

Cremon

et al. 2023

Neurogastroenterology Motil

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BackgroundDiverticular disease (DD) is a common condition in Western countries. The role of microbiota in the pathogenesis of DD and its related symptoms has been frequently postulated since most complications of this disease are bacteria‐driven and most therapies rely on microbiota modulation. Preliminary data showed fecal microbial imbalance in patients with DD, particularly when symptomatic, with an increase of pro‐inflammatory and potentially pathogenetic bacteria. In addition, bacterial metabolic markers can mirror specific pathways of the disease and may be even used for monitoring treatment effects. All treatments currently suggested for DD can affect microbiota structure and metabolome compositions.PurposeSparse evidence is available linking gut microbiota perturbations, diverticular disease pathophysiology, and symptom development. We aimed to summarize the available knowledge on gut microbiota evaluation in diverticular disease, with a focus on symptomatic uncomplicated DD, and the relative treatment strategies.

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“…These microbiome alterations do not affect systemic inflammation, but have relevance only for the gastrointestinal district [106]. Thus, the beneficial effects of rifaximin administration in SUDD and recurrent acute diverticulitis may depend on targeted antibiotic effects on the intestinal microbial communities, probably also inducing shifts in the functionality of bacteria [19,21,107]. Rifaximin also exhibits anti-inflammatory properties that are independent of the gut microbiota composition, making it a "pleiotropic" drug of great interest for the clinical management of diverticular disease and all other gastrointestinal disorders associated with dysbiosis [107].…”

Section: Rifaximinmentioning

confidence: 99%

Diverticular Disease: a Gut Microbiota Perspective

Ticinesi

Nouvenne

Corrente

et al. 2019

JGLD

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Gut microbiota composition and functionality are involved in the pathophysiology of several intestinal andextraintestinal diseases, and are increasingly considered a modulator of local and systemic inflammation.However, the involvement of gut microbiota in diverticulosis and in diverticular disease is still poorlyinvestigated. In this review, we critically analyze the existing evidence on the fecal and mucosa-associatedmicrobiota composition and functionality across different stages of diverticular disease. We also explorethe influence of risk factors for diverticulosis on gut microbiota composition, and speculate on the possiblerelevance of these associations for the pathogenesis of diverticula. We overview the current treatments ofdiverticular disease targeting the intestinal microbiome, highlighting the current areas of uncertainty andthe need for future studies. Although no conclusive remarks on the relationship between microbiota anddiverticular disease can be made, preliminary data suggest that abdominal symptoms are associated withreduced representation of taxa with a possible anti-inflammatory effect, such as Clostridium cluster IV, andovergrowth of Enterobacteriaceae, Bifidobacteria and Akkermansia. The role of the microbiota in the earlystages of the disease is still very uncertain. Future studies should help to disentangle the role of the microbiomein the pathogenesis of diverticular disease and its progression towards more severe forms.

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Rifaximin for the Management of Colonic Diverticular Disease: far Beyond a Simple Antibiotic

Abstract: .

Cited by 9 publications

References 45 publications

Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease

Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease

The role of microbiota and its modulation in colonic diverticular disease

Diverticular Disease: a Gut Microbiota Perspective

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