The DOI matches its Crossref record; 58 of the 58 references it cites were found in a registry or an index.
The Efficacy and Safety of Rifaximin for the Irritable Bowel Syndrome: A Systematic Review and Meta-Analysis
Abstract
OBJECTIVES: Irritable bowel syndrome (IBS) affects 10-15% of the population, and treatment options are limited. Rifaximin is a minimally absorbed antibiotic that has shown efficacy in IBS patients. The objective of our study was to perform a meta-analysis and systematic review of available randomized, placebo controlled trials evaluating the efficacy and tolerability of rifaximin in patients with IBS. METHODS: We performed a systematic literature search of multiple online electronic databases regardless of language. Inclusion criteria entailed randomized, placebo controlled trials and IBS defined by accepted symptom-based criteria. Meta-analysis was conducted to evaluate the summary odds ratios (ORs) and 95% confidence intervals (CIs) of combined studies for the primary and secondary outcomes using a random-effects model based on the DerSimonian and Laird method to reflect both within- and between study variability. We assessed heterogeneity using χ(2) test and the inconsistency index statistic (I(2)). Significant heterogeneity was defined as I(2) ≥25%. Meta-regression was performed using generalized linear mixed-effects model and study as random effects to estimate the summary OR adjusting for covariate differences across studies and treatment group. Publication bias was assessed by funnel plot analysis. RESULTS: Systematic review identified 13,700 citations. Eighteen were deemed to be potentially relevant, of which five articles met eligibility. Meta-analysis found rifaximin to be more efficacious than placebo for global IBS symptom improvement (OR=1.57; 95% CI=1.22, 2.01; therapeutic gain=9.8%; number needed to treat (NNT)=10.2), with mild heterogeneity (P=0.25, I(2)=26%). For the key secondary outcome of bloating, raw data were available for four studies. Rifaximin was significantly more likely to improve bloating than placebo (OR=1.55; 95% CI=1.23-1.96; therapeutic gain=9.9%; NNT=10.1), with no significant heterogeneity (P=0.27, I(2)=23%). We found that studies with older patients and more females demonstrated higher response rates, which was consistent regardless of treatment group. In addition, studies with higher cumulative dose tended to report a higher response rate. Of the covariates evaluated, we found age to be most predictive of response, with a correlation coefficient of 0.97 between aggregate response rate and mean age in the placebo groups. Although studies with higher cumulative dose tended to show increased response rates, this was also seen consistently in both the treated and placebo groups. Adverse effects were similar among patients receiving rifaximin or placebo in all studies. The most common adverse events (AEs) (≤10%) with rifaximin were headache, upper respiratory infection, nausea, nasopharygitis, diarrhea, and abdominal pain. Serious AEs were rare (<1%) and similar with rifaximin and placebo. CONCLUSIONS: Rifaximin proved more effective than placebo for global symptoms and bloating in IBS patients. The modest therapeutic gain was similar to that yielded by other currently available therapies for IBS. AEs were similar between rifaximin and placebo.
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“available metanalysis tend to show a beneficial profile of rifaximin vs placebo on global IBS symptoms and bloating [291]”
From Gut microbiota role in irritable bowel syndrome: New therapeutic strategies (2016) · cites this paper as [291]
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Meta-analysis in clinical trials
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Longstreth, G. F., Thompson, W. G., Chey, W. D., Houghton, L. A., Mearin, F., & Spiller, R. C. (2006) · Gastroenterology · doi:10.1053/j.gastro.2005.11.061 · Cited by 4,856
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COMT val 158 met Genotype Affects µ-Opioid Neurotransmitter Responses to a Pain Stressor
Zubieta, J.-K., Heitzeg, M. M., Smith, Y. R., Bueller, J. A., Xu, K., Xu, Y., Koeppe, R. A., Stohler, C. S., & Goldman, D. A. (2003) · Science · doi:10.1126/science.1078546 · Cited by 1,128
Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation
Pimentel, M., Lembo, A., Chey, W. D., Zakko, S., Ringel, Y., Yu, J., Mareya, S. M., Shaw, A. L., Bortey, E., & Forbes, W. P. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1004409 · Cited by 1,036
Self-citationKassinen, A., Krogius-Kurikka, L., Mäkivuokko, H., Rinttilä, T., Paulin, L., Corander, J., Malinen, E., Apajalahti, J., & Palva, A. (2007) · Gastroenterology · doi:10.1053/j.gastro.2007.04.005 · Cited by 1,002
Altered rectal perception is a biological marker of patients with irritable bowel syndrome
Mertz, H., Naliboff, B. D., Munakata, J., Niazi, N., & Mayer, E. A. (1995) · Gastroenterology · doi:10.1016/0016-5085(95)90267-8 · Cited by 976
Activation of the mucosal immune system in irritable bowel syndrome
Chadwick, V. S., Chen, W., Shu, D., Paulus, B., Bethwaite, P., Tie, A., & Wilson, I. (2002) · Gastroenterology · doi:10.1053/gast.2002.33579 · Cited by 833
Eradication of Small Intestinal Bacterial Overgrowth Reduces Symptoms of Irritable Bowel Syndrome
Pimentel, M., Chow, E. J., & Lin, H. C. (2000) · American Journal of Gastroenterology · doi:10.1111/j.1572-0241.2000.03368.x · Cited by 780
Gender Differences in Treatment Response to Sertraline Versus Imipramine in Chronic Depression
Kornstein, S. G., Schatzberg, A. F., Thase, M. E., Yonkers, K. A., McCullough, J. P., Keitner, G. I., Gelenberg, A. J., Thomas, S., Harrison, W. M., & Keller, M. B. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.9.1445 · Cited by 712
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Irritable bowel syndrome: a clinical review.
Chey, W., Kurlander, J. E., & Eswaran, S. (2015) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2015.0954 · Cited by 748
Self-citationFord, A. C., Moayyedi, P., Lacy, B. E., Lembo, A. J., Saito, Y. A., Schiller, L. R., Soffer, E., Spiegel, B. M. R., & Quigley, E. M. M. (2014) · The American Journal of Gastroenterology · doi:10.1038/ajg.2014.187 · Cited by 664
Brain gut microbiome interactions and functional bowel disorders
Mayer, E. A., Savidge, T., & Shulman, R. J. (2014) · Gastroenterology · doi:10.1053/j.gastro.2014.02.037 · Cited by 496
Melancholic microbes: a link between gut microbiota and depression
Dinan, T. G., & Cryan, J. F. (2013) · Neurogastroenterology & Motility · doi:10.1111/nmo.12198 · Cited by 424
Stress and the Microbiota–Gut–Brain Axis in Visceral Pain: Relevance to Irritable Bowel Syndrome
Moloney, R. D., Johnson, A. C., O’Mahony, S. M., Dinan, T. G., Meerveld, B. G., & Cryan, J. F. (2015) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.12490 · Cited by 409
Metadata
- Authors
- Menees, S. B., Maneerattannaporn, M., Kim, H. M., & Chey, W. D.
- Affiliations
- Michigan Medicine (US)
- Corresponding author
- Chey, William D
- Venue
- American Journal of Gastroenterology
- Published
- 2012-01
- Volume
- 107
- Issue
- 1
- Pages
- 28-35
- ISSN
- 0002-9270 (ISSN-L)
- OpenAlex
- W2049004338
- Cited by
- 283
- References
- 58
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 11 · 2023: 12 · 2022: 13 · 2021: 20 · 2020: 21 · 2019: 13 · 2018: 24 · 2017: 24 · 2016: 29 · 2015: 27 · 2014: 39 · 2013: 21 · 2012: 12
- FWCI
- 3.86
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Health Sciences › Medicine › Gastroenterology › Microscopic Colitis
- Keywords
- rifaximin, irritable bowel syndrome, bloating, treatment efficacy, tolerability, cumulative dose, subgroup analysis, publication bias, number needed to treat, subgroup heterogeneity
- MeSH terms
- Rifaximin, Anti-Infective Agents, Humans, Rifamycins, Randomized Controlled Trials as Topic, Irritable Bowel Syndrome
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