Long‐term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis
Abstract
Background and Aim: Cirrhotic patients are predisposed to intestinal bacterial overgrowth with translocation of bacterial products which may deteriorate liver hemodynamics. Having shown that short‐term administration of rifaximin improves liver hemodynamics in decompensated cirrhosis, we conducted this study to investigate the effect of intestinal decontamination with rifaximin on the long‐term prognosis of patients with alcohol‐related decompensated cirrhosis (C hild‐P ugh > 7) and ascites. Methods: Patients who had received rifaximin and showed improved liver hemodynamics were enrolled in the current study and continued to receive rifaximin (1200 mg/day). Each patient was matched by age, sex, and C hild‐P ugh grade to two controls and followed up for up to 5 years, death or liver transplantation. Survival and risk of developing portal hypertension‐related complications were compared between rifaximin group and controls. Results: Twenty three patients fulfilled the inclusion criteria and matched with 46 controls. Patients who received rifaximin had a significant lower risk of developing variceal bleeding (35% vs 59.5%, P = 0.011), hepatic encephalopathy (31.5% vs 47%, P = 0.034), spontaneous bacterial peritonitis (4.5% vs 46%, P = 0.027), and hepatorenal syndrome (4.5% vs 51%, P = 0.037) than controls. Five‐year cumulative probability of survival was significantly higher in patients receiving rifaximin than in controls (61% vs 13.5%, P = 0.012). In the multivariate analysis, rifaximin administration was independently associated with lower risk of developing variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, and higher survival. Conclusions: In patients with alcohol‐related decompensated cirrhosis, long‐term rifaximin administration is associated with reduced risk of developing complications of portal hypertension and improved survival.
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Rifaximin has been reported to increase survival in advanced liver cirrhosis in several small trials.
“Similar to norfloxacin, rifaximin has been noted to increased survival in patients with advanced liver cirrhosis in several small-scale trials92–95.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [93]
Several small clinical studies suggest that norfloxacin and rifaximin increase survival in patients with liver cirrhosis.
“Moreover, several small-scale clinical studies have suggested that antibiotics such as norfloxacin and rifaximin increase survival in patients with liver cirrhosis92–95.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [93]
Rifaximin appears to reduce spontaneous bacterial peritonitis and may improve portal hypertension, suggesting it effectively targets the gut-liver axis in advanced liver disease.
“Moreover, rifaximin appears to reduce the development of spontaneous bacterial peritonitis and may improve portal hypertension, suggesting that it effectively targets the gut–liver axis in advanced liver disease93,114,115.”
From The gut microbiome and liver cancer: mechanisms and clinical translation (2017) · cites this paper as [93]
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- Authors
- Vlachogiannakos, J., Viazis, N., Vasianopoulou, P., Vafiadis, I., Karamanolis, D. G., & Ladas, S. D.
- Affiliations
- Laiko General Hospital of Athens (GR)
- Evangelismos Hospital (GR)
- Corresponding author
- Vlachogiannakos, Jiannis
- Venue
- Journal of Gastroenterology and Hepatology
- Publisher
- Wiley
- Published
- 2013-02-26
- Volume
- 28
- Issue
- 3
- Pages
- 450-455
- ISSN
- 0815-9319 (ISSN-L)
- 1440-1746
- OpenAlex
- W1606987360
- Cited by
- 206
- References
- 32
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 10 · 2023: 15 · 2022: 23 · 2021: 18 · 2020: 14 · 2019: 20 · 2018: 21 · 2017: 16 · 2016: 14 · 2015: 21 · 2014: 15 · 2013: 6 · 2012: 3
- FWCI
- 9.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Gastroenterology and Hepatology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Keywords
- rifaximin, intestinal decontamination, intestinal bacterial overgrowth, portal hypertension complications, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, survival, ascites, long-term prognosis
- MeSH terms
- Rifaximin, Aged, Drug Administration Schedule, Esophageal and Gastric Varices, Female, Follow-Up Studies, Gastrointestinal Agents, Gastrointestinal Hemorrhage, Hepatic Encephalopathy, Hepatorenal Syndrome, Humans, Hypertension, Portal, Liver Cirrhosis, Alcoholic, Male, Middle Aged, Peritonitis, Prospective Studies, Rifamycins, Multivariate Analysis, Survival Analysis, Treatment Outcome
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