Review article: potential mechanisms of action of rifaximin in the management of hepatic encephalopathy and other complications of cirrhosis

@article{Bajaj2016ReviewAP,
  title={Review article: potential mechanisms of action of rifaximin in the management of hepatic encephalopathy and other complications of cirrhosis},
  author={Jasmohan Singh Bajaj},
  journal={Alimentary Pharmacology \& Therapeutics},
  year={2016},
  volume={43}
}
  • J. Bajaj
  • Published 1 January 2016
  • Medicine
  • Alimentary Pharmacology & Therapeutics
Progressive gut milieu (microbiota) changes occur in patients with cirrhosis and are associated with complications [e.g. hepatic encephalopathy (HE)]. 
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83 Citations
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83 Citations

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Citation Type

Rifaximin‐altered gut microbiota components associated with liver/neuropsychological functions in patients with hepatic encephalopathy: An exploratory data analysis of phase II/III clinical trials
TLDR
Rifaximin (RFX), a non‐systemic antibiotic, improves liver/neuropsychological functions in patients with hepatic encephalopathy (HE) and the effects of RFX on the gut microbiota of patients with HE are investigated.
Effects of rifaximin versus nonabsorbable disaccharides in hepatic encephalopathy
Lactulose is recommended as secondary prophylaxis after the initial episode and rifaximin as an add‐on to lactulose for preventing recurrent episodes of hepatic encephalopathy (HE) after the second…
Rifaximin has minor effects on bacterial composition, inflammation, and bacterial translocation in cirrhosis: A randomized trial
TLDR
A randomized, placebo‐controlled trial investigated the effects of rifaximin on inflammation and BT in decompensated cirrhosis and found that intestinal decontamination with rifaxIMin may reduce bacterial translocation and decrease inflammation.
Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy
Efficacy of rifaximin in the different clinical scenarios of hepatic encephalopathy.
Real‐world effects of long‐term rifaximin treatment for Japanese patients with hepatic encephalopathy
TLDR
This study aimed to investigate the effect of long‐term treatment with RFX on HE and liver function and investigated factors associated with the recurrence of HE under RFX treatment.
Medical Management of Portal Hypertension and Its Complications
Portal hypertension, most commonly caused by cirrhosis, is defined as an elevated hepatic venous pressure gradient that can lead to complications including ascites, hepatic, esophageal/gastric…
Review article: the gut microbiome as a therapeutic target in the pathogenesis and treatment of chronic liver disease
TLDR
Modulation of gut microbiota could prove to be a potential therapeutic target for chronic liver disease because it is intimately linked to the gut via the portal vein.
Gut Microbes and Hepatic Encephalopathy: From the Old Concepts to New Perspectives
TLDR
This review will critically examine the latest research findings on the role of gut microbes in the pathophysiological pathways underlying HE and currently available therapeutic options and novel treatment strategies are discussed.
The Use of Rifaximin in Patients With Cirrhosis
TLDR
It clearly emerges that, due to its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than hepatic encephalopathy deserves to be investigated extensively.
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References

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Systematic review with meta‐analysis: the effects of rifaximin in hepatic encephalopathy
TLDR
Rifaximin is recommended for prevention of hepatic encephalopathy (HE) and its effects on overt and minimal HE are debated.
Review article: the design of clinical trials in hepatic encephalopathy – an International Society for Hepatic Encephalopathy and Nitrogen Metabolism (ISHEN) consensus statement
Aliment Pharmacol Ther 2011; 33: 739–747
Long‐term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis
TLDR
The effect of intestinal decontamination with rifaximin on the long‐term prognosis of patients with alcohol‐related decompensated cirrhosis and ascites is investigated.
Prolonged remission from hepatic encephalopathy with rifaximin: results of a placebo crossover analysis
Rifaximin therapy reduced risk of hepatic encephalopathy (HE) recurrence and HE‐related hospitalisations during a 6‐month, randomised, placebo‐controlled trial (RCT) and a 24‐month open‐label…
Prevention and treatment of hepatic encephalopathy: focusing on gut microbiota.
TLDR
An overview of gut barrier function and the influence of gut-derived factors on HE is provided, focusing on the role of gut microbiota in the pathogenesis of HE and the recent literature findings on its therapeutic manipulation.
Modulation of the Metabiome by Rifaximin in Patients with Cirrhosis and Minimal Hepatic Encephalopathy
TLDR
Rifaximin is associated with improved cognitive function and endotoxemia in MHE, which is accompanied by alteration of gut bacterial linkages with metabolites without significant change in microbial abundance.
Rifaximin in the treatment of hepatic encephalopathy
TLDR
The use and efficacy of rifaximin both in acute and long-term management of hepatic encephalopathy is reviewed, including management of the acute episode as well as maintenance of remission in those patients who have previously experienced an episode, in order to improve their quality of life.
Rifaximine versus neomycin in the treatment of portosystemic encephalopathy.
TLDR
In 14 patients with cirrhosis and chronic portosystemic encephalopathy, the effectiveness of treatment with a new non-assorbable antibiotic (rifaximine) was compared to neomycin; differences, however, were not significant.
The Role of Rifaximin in the Primary Prophylaxis of Spontaneous Bacterial Peritonitis in Patients With Liver Cirrhosis
TLDR
Intestinal decontamination with rifaximin may prevent SBP in cirrhotic patients with ascites, and prospective randomized controlled trials are needed to confirm this finding.
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