A randomized double-blind placebo-controlled trial of rifaximin in patients with abdominal bloating and flatulence.

Abstract

AIMS:

To study the efficacy of rifaximin, a nonabsorbable antibiotic, in relieving chronic functional symptoms of bloating and flatulence.

METHODS:

Randomized double-blind placebo-controlled trial consisting of three 10-day phases: baseline (phase 1), treatment with rifaximin 400 mg b.i.d. or placebo (phase 2), and post-treatment period (phase 3). Primary efficacy variable was subjective global symptom relief at the end of each phase. A symptom score was calculated from a symptom diary. Lactulose H2-breath test (LHBT) was performed at baseline and end of study.

RESULTS:

One hundred and twenty-four patients were enrolled (63 rifaximin and 61 placebo). Baseline characteristics were comparable and none had an abnormal baseline LHBT. Rome II criteria were met in 58.7% and 54.1%, respectively. At the end of phase 2, there was a significant difference in global symptom relief with rifaximin versus placebo (41.3% vs 22.9%, p = 0.03). This improvement was maintained at the end of phase 3 (28.6% vs 11.5%, p = 0.02). Mean cumulative and bloating-specific scores dropped significantly in the rifaximin group (p < 0.05). Among patients with IBS, a favorable response to rifaximin was noted (40.5% vs 18.2%; p = 0.04) persisting by the end of phase 3 (27% vs 9.1%; p = 0.05). H2-breath excretion dropped significantly among rifaximin responders and correlated with improvement in bloating and overall symptom scores (p = 0.01). No adverse events were reported.

CONCLUSIONS:

Rifaximin is a safe and effective treatment for abdominal bloating and flatulence, including in IBS patients. Symptom improvement correlates with reduction in H2-breath excretion. Future trials are needed to examine the efficacy of long-term or cyclic rifaximin in functional colonic disorders.

• Authors: Ala I Sharara, Elie Aoun, Heitham Abdul-Baki, Rawad Mounzer, Shafik Sidani, Ihab Elhajj
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 101 Issue 2 Pg. 326-33 (Feb 2006) ISSN: 0002-9270 [Print] United States
• PMID: 16454838 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• Gastrointestinal Agents
• Rifamycins
• Lactulose
• Hydrogen
• Rifaximin

Topics

• Adult
• Breath Tests
• Double-Blind Method
• Female
• Flatulence (diagnosis, drug therapy)
• Follow-Up Studies
• Gastrointestinal Agents (therapeutic use)
• Humans
• Hydrogen (analysis)
• Lactulose
• Male
• Rifamycins (therapeutic use)
• Rifaximin
• Treatment Outcome