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Antibiotic treatment of constipation-predominant irritable bowel syndrome.
Dig Dis Sci 2014; 59(6):1278-85DD

Abstract

BACKGROUND

The antibiotic rifaximin is used to treat non-constipated irritable bowel syndrome (IBS). Methane production is associated with constipation and its severity in constipation-predominant IBS (C-IBS). A previous retrospective study suggested that rifaximin and neomycin was superior to neomycin alone in improving symptoms in methane-positive subjects.

AIMS

To determine the effectiveness of neomycin alone or with rifaximin in improving symptoms in methane-positive C-IBS subjects.

METHODS

A double-blind, randomized, placebo-controlled trial was performed from 2010 to 2013 at three tertiary care centers. Subjects aged 18-65 with C-IBS (Rome II criteria) and breath methane (>3 ppm) meeting the inclusion and exclusion criteria were recruited. Subjects completed a baseline symptom questionnaire rating the severity of abdominal and bowel symptoms on a visual analog scale and were randomized to receive neomycin and placebo or neomycin and rifaximin for 14 days. Symptom severity was assessed by weekly questionnaire for 2 weeks of therapy and 4 additional weeks of follow-up.

RESULTS

Thirty-one subjects (16 neomycin and placebo, 15 neomycin and rifaximin) were included in the intention-to-treat analysis. Constipation severity was significantly lower in the neomycin and rifaximin group (28.6 ± 30.8) compared to neomycin alone (61.2 ± 24.1) (P = 0.0042), with greater improvement in constipation (P = 0.007), straining (P = 0.017) and bloating (P = 0.020), but not abdominal pain. In the neomycin and rifaximin group, subjects with methane <3 ppm after treatment reported significantly lower constipation severity (30.5 ± 21.8) than subjects with persistent methane (67.2 ± 32.1) (P = 0.020).

CONCLUSIONS

Rifaximin plus neomycin is superior to neomycin alone in improving multiple C-IBS symptoms. This effect is predicted by a reduction in breath methane.

Authors+Show Affiliations

GI Motility Program, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA, pimentelm@cshs.org.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24788320

Citation

Pimentel, Mark, et al. "Antibiotic Treatment of Constipation-predominant Irritable Bowel Syndrome." Digestive Diseases and Sciences, vol. 59, no. 6, 2014, pp. 1278-85.
Pimentel M, Chang C, Chua KS, et al. Antibiotic treatment of constipation-predominant irritable bowel syndrome. Dig Dis Sci. 2014;59(6):1278-85.
Pimentel, M., Chang, C., Chua, K. S., Mirocha, J., DiBaise, J., Rao, S., & Amichai, M. (2014). Antibiotic treatment of constipation-predominant irritable bowel syndrome. Digestive Diseases and Sciences, 59(6), pp. 1278-85. doi:10.1007/s10620-014-3157-8.
Pimentel M, et al. Antibiotic Treatment of Constipation-predominant Irritable Bowel Syndrome. Dig Dis Sci. 2014;59(6):1278-85. PubMed PMID: 24788320.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Antibiotic treatment of constipation-predominant irritable bowel syndrome. AU - Pimentel,Mark, AU - Chang,Christopher, AU - Chua,Kathleen Shari, AU - Mirocha,James, AU - DiBaise,John, AU - Rao,Satish, AU - Amichai,Meridythe, Y1 - 2014/05/01/ PY - 2014/01/15/received PY - 2014/04/05/accepted PY - 2014/5/3/entrez PY - 2014/5/3/pubmed PY - 2014/7/16/medline SP - 1278 EP - 85 JF - Digestive diseases and sciences JO - Dig. Dis. Sci. VL - 59 IS - 6 N2 - BACKGROUND: The antibiotic rifaximin is used to treat non-constipated irritable bowel syndrome (IBS). Methane production is associated with constipation and its severity in constipation-predominant IBS (C-IBS). A previous retrospective study suggested that rifaximin and neomycin was superior to neomycin alone in improving symptoms in methane-positive subjects. AIMS: To determine the effectiveness of neomycin alone or with rifaximin in improving symptoms in methane-positive C-IBS subjects. METHODS: A double-blind, randomized, placebo-controlled trial was performed from 2010 to 2013 at three tertiary care centers. Subjects aged 18-65 with C-IBS (Rome II criteria) and breath methane (>3 ppm) meeting the inclusion and exclusion criteria were recruited. Subjects completed a baseline symptom questionnaire rating the severity of abdominal and bowel symptoms on a visual analog scale and were randomized to receive neomycin and placebo or neomycin and rifaximin for 14 days. Symptom severity was assessed by weekly questionnaire for 2 weeks of therapy and 4 additional weeks of follow-up. RESULTS: Thirty-one subjects (16 neomycin and placebo, 15 neomycin and rifaximin) were included in the intention-to-treat analysis. Constipation severity was significantly lower in the neomycin and rifaximin group (28.6 ± 30.8) compared to neomycin alone (61.2 ± 24.1) (P = 0.0042), with greater improvement in constipation (P = 0.007), straining (P = 0.017) and bloating (P = 0.020), but not abdominal pain. In the neomycin and rifaximin group, subjects with methane <3 ppm after treatment reported significantly lower constipation severity (30.5 ± 21.8) than subjects with persistent methane (67.2 ± 32.1) (P = 0.020). CONCLUSIONS: Rifaximin plus neomycin is superior to neomycin alone in improving multiple C-IBS symptoms. This effect is predicted by a reduction in breath methane. SN - 1573-2568 UR - https://www.unboundmedicine.com/medline/citation/24788320/Antibiotic_treatment_of_constipation_predominant_irritable_bowel_syndrome_ L2 - https://doi.org/10.1007/s10620-014-3157-8 DB - PRIME DP - Unbound Medicine ER -