Department of Internal Medicine, Gastroenterology and Hepatology, Sechenov University, Moscow, Russian Federation.
Scientific Community for the Human Microbiome Research, Moscow, Russian Federation.
BMC Gastroenterol. 2023 Mar 23;23(1):82. doi: 10.1186/s12876-023-02690-x.
Rifaximin effectively treats symptomatic uncomplicated diverticular disease (SUDD) and has shown eubiotic potential (i.e., an increase in resident microbial elements with potential beneficial effects) in other diseases. This study investigated changes in the fecal microbiome of patients with SUDD after repeated monthly treatment with rifaximin and the association of these changes with the severity of abdominal pain.
This was a single-center, prospective, observational, uncontrolled cohort study. Patients received rifaximin 400 mg twice a day for 7 days per month for 6 months. Abdominal pain (assessed on a 4-point scale from 0 [no pain] to 3 [severe pain]) and fecal microbiome (assessed using 16 S rRNA gene sequencing) were assessed at inclusion (baseline) and 3 and 6 months. The Spearman's rank test analyzed the relationship between changes in the gut microbiome and the severity of abdominal pain. A p-value ≤ 0.05 was considered statistically significant.
Of the 23 patients enrolled, 12 patients completed the study and were included in the analysis. Baseline abdominal pain levels decreased significantly after 3 (p = 0.036) and 6 (p = 0.008) months of treatment with rifaximin. The abundance of Akkermansia in the fecal microbiome was significantly higher at 3 (p = 0.017) and 6 (p = 0.015) months versus baseline. The abundance of Ruminococcaceae (p = 0.034), Veillonellaceae (p = 0.028), and Dialister (p = 0.036) were significantly increased at 6 months versus baseline, whereas Anaerostipes (p = 0.049) was significantly decreased. The severity of abdominal pain was negatively correlated with the abundance of Akkermansia (r=-0.482; p = 0.003) and Ruminococcaceae (r=-0.371; p = 0.026) but not with Veillonellaceae, Dialister, or Anaerostipes. After 3 months of rifaximin, abdominal pain was significantly less in patients with Akkermansia in their fecal microbiome than in patients without Akkermansia (p = 0.022).
The eubiotic effect of rifaximin was associated with decreased abdominal pain in patients with SUDD.
利福昔明可有效治疗有症状的单纯性憩室病（SUDD），并且在其他疾病中表现出有益生作用（即增加具有潜在有益作用的常驻微生物成分）。本研究调查了 SUDD 患者在接受利福昔明每月重复治疗后粪便微生物组的变化，以及这些变化与腹痛严重程度的关系。
这是一项单中心、前瞻性、观察性、非对照队列研究。患者接受利福昔明 400mg，每日 2 次，连续 7 天，每月 1 次，共 6 个月。腹痛（采用 0 到 3 分的 4 分制评估，0 分表示无疼痛，3 分表示严重疼痛）和粪便微生物组（采用 16S rRNA 基因测序评估）在纳入（基线）时和 3 个月和 6 个月时进行评估。采用 Spearman 秩检验分析肠道微生物组的变化与腹痛严重程度之间的关系。p 值≤0.05 被认为具有统计学意义。
在纳入的 23 名患者中，有 12 名患者完成了研究并纳入了分析。在接受利福昔明治疗 3 个月（p=0.036）和 6 个月（p=0.008）后，基线腹痛水平显著降低。粪便微生物组中 Akkermansia 的丰度在 3 个月（p=0.017）和 6 个月（p=0.015）时均显著高于基线。Ruminococcaceae（p=0.034）、Veillonellaceae（p=0.028）和 Dialister（p=0.036）的丰度在 6 个月时显著高于基线，而 Anaerostipes（p=0.049）的丰度则显著降低。腹痛严重程度与 Akkermansia（r=-0.482；p=0.003）和 Ruminococcaceae（r=-0.371；p=0.026）的丰度呈负相关，但与 Veillonellaceae、Dialister 或 Anaerostipes 无关。在接受利福昔明治疗 3 个月后，粪便微生物组中存在 Akkermansia 的患者腹痛程度明显低于无 Akkermansia 的患者（p=0.022）。
利福昔明的有益生作用与 SUDD 患者的腹痛减轻有关。
