García-Cedillo María Fernanda, Villegas-García Federico Ulises, Arenas-Martinez Josealberto Sebastiano, Ornelas-Arroyo Victoria Jaqueline, Yamamoto-Furusho Jesús Kazuo, Estrella-Sato Luis Alberto, Coss-Adame Enrique
Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Gastrointestinal Motility Laboratory, Department of Gastroenterology, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico D.F., Mexico.
Dig Dis Sci. 2025 Jan;70(1):360-366. doi: 10.1007/s10620-024-08767-1. Epub 2024 Dec 6.
Irritable bowel syndrome symptoms are associated with diverse pathophysiological mechanisms including small intestinal bacterial overgrowth and food intolerance. Small intestinal bacterial overgrowth leads to the decreased activity of several digestive enzymes, including lactase.
To assess the efficacy of rifaximin-alpha on the symptoms and lactase activity of patients with irritable bowel syndrome without constipation.
This was a prospective, pilot study. The recruited patients had irritable bowel syndrome without constipation (Rome IV criteria), a positive lactulose-Hydrogen Breath Test for small intestinal bacterial overgrowth, low urinary D-Xylose levels measured using the Lactest® test, and self-reported lactose intolerance. In addition, lactose HBT was performed. All patients received 400 mg rifaximin-alpha every 8 h for 2 weeks. Four weeks after the intervention, lactose and lactulose HBT were performed, and the symptoms and urinary D-Xylose levels were evaluated.
After treatment with rifaximin-alpha, 60% of the patients reported improvement in abdominal pain, 44% in bloating, 36% in flatulence, 60% in borborygmi, and 72% in stool consistency. A negative lactulose-Hydrogen Breath Test result for SIBO was documented in 32% of patients, and lactose maldigestion by lactose-Hydrogen Breath Test was reduced from 88 to 52% of the studied subjects. The median D-Xylose levels before and after treatment were 7.6 (IQR 4.34-13.7) mg/dL vs. 10.4 (IQR 7.1-17.3) mg/dL, p = 0.002.
Rifaximin-alpha caused symptomatic improvement, reduced lactose maldigestion, and reduced positive Hydrogen Breath Test results for small intestinal bacterial overgrowth in patients with irritable bowel syndrome without constipation.
肠易激综合征症状与多种病理生理机制相关，包括小肠细菌过度生长和食物不耐受。小肠细菌过度生长会导致多种消化酶活性降低，包括乳糖酶。
评估利福昔明-α对无便秘型肠易激综合征患者症状及乳糖酶活性的疗效。
这是一项前瞻性试点研究。招募的患者符合无便秘型肠易激综合征（罗马IV标准），乳糖-氢呼气试验显示小肠细菌过度生长阳性，使用Lactest®检测法测得低尿D-木糖水平，且有自我报告的乳糖不耐受。此外，进行了乳糖氢呼气试验。所有患者每8小时服用400mg利福昔明-α，持续2周。干预4周后，进行乳糖和乳果糖氢呼气试验，并评估症状及尿D-木糖水平。
使用利福昔明-α治疗后，60%的患者报告腹痛改善，44%腹胀改善，36%肠胃胀气改善，60%肠鸣音改善，72%大便性状改善。32%的患者乳糖-氢呼气试验结果显示小肠细菌过度生长为阴性，乳糖氢呼气试验显示乳糖消化不良的研究对象比例从88%降至52%。治疗前后尿D-木糖水平中位数分别为7.6（四分位间距4.34 - 13.7）mg/dL和10.4（四分位间距7.1 - 17.3）mg/dL，p = 0.002。
利福昔明-α可改善无便秘型肠易激综合征患者的症状，减少乳糖消化不良，并降低小肠细菌过度生长的氢呼气试验阳性结果。
