Meta-analysis: long-term therapy with rifaximin in the management of uncomplicated diverticular disease.

Abstract

BACKGROUND:

Diverticular disease of the colon is a common gastrointestinal disease. Although most patients remain asymptomatic for their whole life, about 20-25% present symptoms related to 'diverticular disease'. Several randomised trials verified efficacy of a poorly absorbed antibiotic, such as rifaximin-α (rifaximin), in soothing symptoms and preventing diverticulitis.

AIM:

To evaluate the long-term efficacy administration of rifaximin plus fibre supplementation vs. fibre supplementation alone, on symptoms and complications, in patient with symptomatic uncomplicated diverticular disease.

METHODS:

Pertinent studies were selected from the Medline, and the Cochrane Library Databases, references from published articles and reviews. Conventional meta-analysis according to DerSimonian and Laird method was used for the pooling of the results. The outcomes were 1- year complete symptom relief, and 1- year complication incidence. The rate difference (RD, with 95% CI) and the Number Needed to Treat (NNT) were used as measure of the therapeutic effect on each outcome.

RESULTS:

Four prospective randomised trials including 1660 patients were selected. The pooled RD for symptom relief was 29.0% (rifaximin vs. control; 95% CI 24.5-33.6%; P<0.0001; NNT=3). The pooled RD for complication rate was -1.7% in favour of rifaximin (95% CI -3.2 to -0.1%; P=0.03; NNT=59). When considering only acute diverticulitis, the pooled RD in the treatment group was -2% (95% CI -3.4 to -0.6%; P=0.0057; NNT=50).

CONCLUSIONS:

In symptomatic uncomplicated diverticular disease, treatment with rifaximin plus fibre supplementation is effective in obtaining symptom relief and preventing complications at 1 year.

• Authors: M Bianchi, V Festa, A Moretti, A Ciaco, M Mangone, V Tornatore, A Dezi, R Luchetti, B De Pascalis, C Papi, M Koch
• Journal: Alimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 33 Issue 8 Pg. 902-10 (Apr 2011) ISSN: 1365-2036 [Electronic] England
• PMID: 21366632 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)
• Copyright: © 2011 Blackwell Publishing Ltd.

Chemical References

• Dietary Fiber
• Gastrointestinal Agents
• Rifamycins
• Rifaximin

Topics

• Case-Control Studies
• Dietary Fiber (administration & dosage)
• Diverticulum, Colon (complications, drug therapy)
• Gastrointestinal Agents (therapeutic use)
• Humans
• Rifamycins (administration & dosage)
• Rifaximin
• Treatment Outcome