乳果糖呼气试验预测利福昔明治疗腹泻型肠易激综合征的疗效。

Lactulose Breath Testing as a Predictor of Response to Rifaximin in Patients With Irritable Bowel Syndrome With Diarrhea.

机构信息

GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, California, USA.

Salix Pharmaceuticals, Bridgewater, New Jersey, USA.

出版信息

Am J Gastroenterol. 2019 Dec;114(12):1886-1893. doi: 10.14309/ajg.0000000000000444.

DOI:10.14309/ajg.0000000000000444

PMID:31688023

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6903366/

Abstract

OBJECTIVES

The nonsystemic antibiotic rifaximin is indicated for irritable bowel syndrome with diarrhea (IBS-D) in adults; however, determinants of response remain unclear. The utility of lactulose breath testing (LBT) in predicting response to rifaximin was examined.

METHODS

Adults with IBS-D received open-label rifaximin 550 mg 3 times daily for 2 weeks, followed by a 4-week posttreatment assessment period. Thirteen centers prospectively participated in this substudy. LBT was conducted before (day 1) and after (day 14) therapy (breath samples obtained every 15 minutes; up to 240 minutes). Patient response (decrease from baseline of ≥30% in abdominal pain and ≥50% decrease in frequency of mushy/watery stool), symptom improvement, and the relationship of clinical outcomes to LBT results were assessed.

RESULTS

A total of 93 patients were included; 62 (66.7%) had positive baseline LBT results. Overall, 48.4% (45/93) of patients responded to rifaximin; of these, 59.7% (37/62) had a positive baseline LBT vs 25.8% (8/31) with a negative LBT (P = 0.002; odds ratio 4.3, 95% confidence interval, 1.5-12.7). Patients with a positive baseline LBT result experienced significantly greater improvement from baseline in 6 of 7 individual IBS symptoms. LBT results after rifaximin therapy did not correlate with clinical response in the 86 patients with evaluable breath tests (P = 0.21); however, patients whose LBT results normalized after rifaximin had the highest response rate of 76.5% (13/17).

DISCUSSION

A positive baseline LBT result predicted a higher likelihood of response to rifaximin in IBS-D, suggesting a gut microbiome modulatory mechanism of action for rifaximin.

摘要

目的

非系统性抗生素利福昔明适用于成人腹泻型肠易激综合征（IBS-D）；然而，反应的决定因素仍不清楚。研究了乳果糖呼气试验（LBT）预测利福昔明反应的效用。

方法

IBS-D 成人接受利福昔明 550mg，每日 3 次，开放标签治疗 2 周，随后进行为期 4 周的治疗后评估期。13 个中心前瞻性参与了这项子研究。在治疗前（第 1 天）和治疗后（第 14 天）进行 LBT（呼吸样本每 15 分钟采集一次；最多 240 分钟）。评估患者反应（腹痛缓解≥30%，大便松软/水样频率减少≥50%）、症状改善以及临床结果与 LBT 结果的关系。

结果

共纳入 93 例患者；62 例（66.7%）基线 LBT 结果阳性。总体而言，48.4%（45/93）的患者对利福昔明有反应；其中，59.7%（37/62）基线 LBT 阳性患者与 25.8%（8/31）基线 LBT 阴性患者相比（P=0.002；比值比 4.3，95%置信区间，1.5-12.7）。基线 LBT 阳性患者的 7 种 IBS 症状中的 6 种症状从基线水平显著改善。在 86 例可评估呼气试验的患者中，利福昔明治疗后的 LBT 结果与临床反应不相关（P=0.21）；然而，利福昔明治疗后 LBT 结果正常的患者反应率最高，为 76.5%（13/17）。