Department of Internal Medicine, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
Department of Tropical Medicine, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
Arab J Gastroenterol. 2020 Dec;21(4):273-277. doi: 10.1016/j.ajg.2020.08.003. Epub 2020 Sep 12.
Although unclear, the pathophysiology of irritable bowel syndrome (IBS) is considered to be multifactorial. Recent studies have suggested that IBS is a low-grade inflammatory bowel disease (IBD) with high faecal calprotectin (FC) levels. Rifaximin is a potential therapeutic agent for IBS with diarrhoea (IBS-D) due to its ability to decrease FC levels. This study evaluated the role of FC as a follow-up marker of IBS-D after short-course rifaximin treatment.
Ninety-six patients with chronic diarrhoea who fulfilled the Rome IV criteria for IBS-D were enrolled in this study from outpatient clinics. After excluding 18 patients who did not complete the study due to treatment noncompliance or missing follow-up visits, 78 patients (mean age, 39.2 ± 6.9 years) with IBS-D and elevated baseline FC levels were included. An FC level of <50 μg/g was considered normal. Abdominal symptoms were assessed using a Likert scale. All patients received oral rifaximin (550 mg three times daily) for 2 weeks, followed by assessment for abdominal symptoms and FC levels; the treatment was extended to 4 weeks if FC levels remained elevated after 2 weeks of treatment.
FC levels normalised in 66 (84.6%) patients, including 60 and 6 patients treated for 2 and 4 weeks, respectively. The remaining 12 (15.4%) patients with persistently elevated FC levels despite 4 weeks of treatment also showed a significant decline in their final FC levels compared with the baseline, accompanied with a significant improvement in abdominal symptoms (p = 0.001). A cutoff baseline FC value of 148.5 μg/g could predict non-responders with 100% sensitivity and 50% specificity.
Short-course oral rifaximin treatment results in FC normalisation in IBS-D patients with high baseline FC values. Therefore, FC should be considered as a biomarker of follow-up after rifaximin treatment for IBS-D.
虽然尚不清楚，但肠易激综合征（IBS）的病理生理学被认为是多因素的。最近的研究表明，IBS 是一种低级别炎症性肠病（IBD），粪便钙卫蛋白（FC）水平较高。利福昔明由于能够降低 FC 水平，是治疗腹泻型肠易激综合征（IBS-D）的潜在治疗药物。本研究评估了 FC 作为 IBS-D 短期利福昔明治疗后随访标志物的作用。
从门诊招募了 96 例符合 Rome IV 标准的慢性腹泻 IBS-D 患者，纳入本研究。排除因治疗不依从或随访缺失而未完成研究的 18 例患者后，共纳入 78 例 IBS-D 患者（平均年龄 39.2±6.9 岁），基线 FC 水平升高。<50μg/g 被认为是正常的。采用李克特量表评估腹部症状。所有患者均接受口服利福昔明（550mg，每日 3 次）治疗 2 周，然后评估腹部症状和 FC 水平；如果治疗 2 周后 FC 水平仍升高，则延长治疗至 4 周。
66 例（84.6%）患者的 FC 水平正常化，其中 60 例和 6 例分别接受 2 周和 4 周治疗。尽管接受了 4 周治疗，但其余 12 例（15.4%）FC 水平持续升高的患者的最终 FC 水平与基线相比也显著下降，且腹部症状显著改善（p=0.001）。基线 FC 值为 148.5μg/g 时，可以预测无反应者，其敏感性为 100%，特异性为 50%。
短期口服利福昔明治疗可使基线 FC 值较高的 IBS-D 患者的 FC 水平正常化。因此，FC 应被视为 IBS-D 利福昔明治疗后随访的生物标志物。
