Published online Nov 21, 2015. doi: 10.3748/wjg.v21.i43.12322
Peer-review started: July 3, 2015
First decision: August 31, 2015
Revised: September 3, 2015
Accepted: October 17, 2015
Article in press: October 20, 2015
Published online: November 21, 2015
Liver cirrhosis is a paradigm of intestinal dysbiosis. The qualitative and quantitative derangement of intestinal microbial community reported in cirrhotic patients seems to be strictly related with the impairment of liver function. A kind of gut microbial “fingerprint”, characterized by the reduced ratio of “good” to “potentially pathogenic” bacteria has recently been outlined, and is associated with the increase in Model for End-Stage Liver Disease and Child Pugh scores. Moreover, in patients presenting with cirrhosis complications such as spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and, portal hypertension intestinal microbiota modifications or the isolation of bacteria deriving from the gut are commonly reported. Rifaximin is a non-absorbable antibiotic used in the management of several gastrointestinal diseases. Beyond bactericidal/bacteriostatic, immune-modulating and anti-inflammatory activity, a little is known about its interaction with gut microbial environment. Rifaximin has been demonstrated to exert beneficial effects on cognitive function in patients with HE, and also to prevent the development of SBP, to reduce endotoxemia and to improve hemodynamics in cirrhotics. These results are linked to a shift in gut microbes functionality, triggering the production of favorable metabolites. The low incidence of drug-related adverse events due to the small amount of circulating drug makes rifaximin a relatively safe antibiotic for the modulation of gut microbiota in advanced liver disease.
Core tip: Advanced liver disease is characterized by intestinal dysbiosis, which has been involved in the pathogenesis of complications. Rifaximin is able to improve cognitive tests and practical abilities, to reduce the risk of hepatic encephalopathy (HE) recurrence and the number of HE-related hospitalizations. Rifaximin efficacy seems not associated with major changes in gut bacteria composition but rather with a shift in the microbiome functionality. Rifaximin is useful in the prevention of spontaneous bacterial peritonitis in patients with ascites. Rifaximin reduces endotoxemia and has beneficial effects on cirrhotic patients hemodynamics, reducing the incidence of complications related to portal hypertension.