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Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Can Antibiotics Improve the Symptoms of the Irritable Bowel Syndrome?
17 October 2006 | Volume 145 Issue 8 | Page I-24
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "The Effect of a Nonabsorbed Oral Antibiotic (Rifaximin) on the Symptoms of the Irritable Bowel Syndrome. A Randomized Trial." It is in the 17 October 2006 issue of Annals of Internal Medicine (volume 145, pages 557-563). The authors are M. Pimentel, S. Park, J. Mirocha, S.V. Kane, and Y. Kong.
What is the problem and what is known about it so far?
The irritable bowel syndrome (IBS) causes symptoms of cramping, bloating, gas, diarrhea, and constipation for no apparent reason. The cause of IBS is uncertain, but some evidence suggests that IBS is caused by an abnormal growth of bacteria. If bacteria contribute to IBS, then treatment with antibiotics might be helpful.
Why did the researchers do this particular study?
To determine whether rifaximin, an antibiotic that works only in the gut, can improve symptoms in people with IBS.
Who was studied?
87 people with IBS at 2 medical centers.
How was the study done?
After recording symptoms for a week in a symptom diary, participants were assigned at random to receive rifaximin or placebo for 10 days. They recorded their symptoms weekly for 10 weeks after they stopped taking the drug or placebo. The researchers then compared the severity of symptoms in the 2 groups.
What did the researchers find?
Bloating and overall symptoms improved in participants who took the antibiotic. However, the researchers could not detect a difference in symptoms of diarrhea or constipation. Rifaximin did not cause any clinically significant side effects.
What were the limitations of the study?
A relatively small number of patients and a short duration limited the study's findings. The findings might differ if more participants were studied and if patients were followed for a longer period of time.
What are the implications of the study?
Rifaximin taken for 10 days seems to provide some relief of symptoms to people with IBS.
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  M. A. McOmber and R. J. Shulman Pediatric Functional Gastrointestinal Disorders Nutr Clin Pract, June 1, 2008; 23(3): 268 - 274. [Abstract] [Full Text] [PDF]
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 E. A. Mayer Irritable Bowel Syndrome N. Engl. J. Med., April 17, 2008; 358(16): 1692 - 1699. [Full Text] [PDF]
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 A. L Fumi and K. Trexler Rifaximin Treatment for Symptoms of Irritable Bowel Syndrome Ann. Pharmacother., March 1, 2008; 42(3): 408 - 412. [Abstract] [Full Text] [PDF]
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 E. M M Quigley Probiotics in Irritable Bowel Syndrome: An Immunomodulatory Strategy? J. Am. Coll. Nutr., December 1, 2007; 26(6): 684S - 690S. [Abstract] [Full Text] [PDF]
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 R Spiller, Q Aziz, F Creed, A Emmanuel, L Houghton, P Hungin, R Jones, D Kumar, G Rubin, N Trudgill, et al. Guidelines on the irritable bowel syndrome: mechanisms and practical management Gut, December 1, 2007; 56(12): 1770 - 1798. [Abstract] [Full Text] [PDF]
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 E. C. Lauritano, A. L. Bilotta, M. Gabrielli, E. Scarpellini, A. Lupascu, A. Laginestra, M. Novi, S. Sottili, M. Serricchio, G. Cammarota, et al. Association between Hypothyroidism and Small Intestinal Bacterial Overgrowth J. Clin. Endocrinol. Metab., November 1, 2007; 92(11): 4180 - 4184. [Abstract] [Full Text] [PDF]
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 Other articles noted Evid. Based Med., February 1, 2007; 12(1): 31 - 32. [Full Text] [PDF]
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 Rifaximin for Irritable Bowel Syndrome Journal Watch (General), November 9, 2006; 2006(1109): 4 - 4. [Full Text]
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 D. A. Drossman Treatment for bacterial overgrowth in the irritable bowel syndrome. Ann Intern Med, October 17, 2006; 145(8): 626 - 628. [Full Text] [PDF]
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 Another Small Step Forward in Treating Patients with IBS Journal Watch Gastroenterology, October 16, 2006; 2006(1016): 1 - 1. [Full Text]
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