GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Aliment Pharmacol Ther. 2016 Jan;43 Suppl 1:37-49. doi: 10.1111/apt.13437.
The role of gut microbiota in the pathophysiology of irritable bowel syndrome (IBS) is supported by various lines of evidence, including differences in mucosal and faecal microbiota between patients with IBS and healthy individuals, development of post-infectious IBS, and the efficacy of some probiotics and nonsystemic antibiotics (e.g. rifaximin).
To review the literature regarding the role of rifaximin in IBS and its potential mechanism(s) of action.
A literature search was conducted using the terms 'rifaximin', 'irritable bowel syndrome' and 'mechanism of action'.
Rifaximin was approved in 2015 for the treatment of IBS with diarrhoea. In contrast to other currently available IBS therapies that require daily administration to maintain efficacy, 2-week rifaximin treatment achieved symptom improvement that persisted ≥12 weeks post-treatment. The mechanisms of action of rifaximin, therefore, may extend beyond direct bactericidal effects. Data suggest that rifaximin may decrease host proinflammatory responses to bacterial products in patients with IBS. In some cases, small intestinal bacterial overgrowth (SIBO) may play a role in the clinical symptoms of IBS. Because of the high level of solubility of rifaximin in the small intestine, rifaximin may reset microbial diversity in this environment. Consistent with this hypothesis, rifaximin has antibiotic efficacy against isolates derived from patients with SIBO.
Resetting microbial diversity via rifaximin use may lead to a decrease in bacterial fermentation and a reduction in the clinical symptoms of IBS.
肠道微生物群在肠易激综合征（IBS）的病理生理学中的作用得到了多方面证据的支持，包括 IBS 患者与健康个体之间粘膜和粪便微生物群的差异、感染后 IBS 的发展以及某些益生菌和非系统性抗生素（例如利福昔明）的疗效。
综述利福昔明在 IBS 中的作用及其潜在作用机制。
使用“利福昔明”、“肠易激综合征”和“作用机制”等术语进行文献检索。
利福昔明于 2015 年被批准用于治疗腹泻型 IBS。与其他目前可用的 IBS 治疗方法不同，这些方法需要每日给药以维持疗效，而 2 周的利福昔明治疗可实现持续≥12 周的症状改善。因此，利福昔明的作用机制可能超出了直接杀菌作用。数据表明，利福昔明可能会降低 IBS 患者对细菌产物的宿主促炎反应。在某些情况下，小肠细菌过度生长（SIBO）可能在 IBS 的临床症状中起作用。由于利福昔明在小肠中的高溶解度，利福昔明可能会重置该环境中的微生物多样性。这一假设与利福昔明对来自 SIBO 患者的分离株具有抗生素疗效一致。
通过利福昔明的使用重置微生物多样性可能会导致细菌发酵减少和 IBS 临床症状减轻。
