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
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.