Kvit K. B.

POSSIBILITIES OF USING OF RIFAXIMIN IN MANAGING SMALL INTESTINAL BACTERIAL OVERGROWTH IN PATIENTS WITH NONALCOHOLIC FATTY LIVER DISEASE

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About the author:

Kvit K. B.

Heading:

CLINICAL AND EXPERIMENTAL MEDICINE

Type of article:

Scientific article

Annotation:

Nonalcoholic fatty liver disease (NAFLD) is a common metabolic disorder frequently accompanied by small intestinal bacterial overgrowth (SIBO). SIBO exacerbates NAFLD progression through systemic inflammation, impaired intestinal barrier function, and metabolic disturbances. Rifaximin, an antibiotic with minimal systemic absorption, has proven effective in treating SIBO by improving microbiota composition and reducing inflammatory processes. Aim is to determine the prevalence of SIBO in patients with NAFLD, assess the effect of rifaximin on clinical, biochemical, and metabolic parameters, and explore its potential use in treating this condition. The study included 152 patients with NAFLD and 47 individuals in the control group. SIBO was diagnosed using the hydrogen breath test. All NAFLD patients received rifaximin (200 mg three times daily for 14 days). Clinical symptoms, biochemical indicators, lipid profile, and ultrasound parameters were evaluated before and after treatment. SIBO was detected in 50% of NAFLD patients compared to 23.4% in the control group. After therapy, the prevalence of SIBO decreased to 32.4%, and clinical symptoms (abdominal pain, bloating, flatulence) significantly improved (p≤0.05). Biochemical indicators such as ALT, AST, high-sensitivity CRP, alkaline phosphatase, and HOMA-IR index were significantly reduced. The lipid profile also improved, with reductions in total cholesterol and triglycerides and an increase in HDL-C levels. Rifaximin effectively reduces SIBO prevalence, improves gastrointestinal symptoms, and positively impacts biochemical and metabolic parameters in NAFLD patients. Its use may represent a promising direction in the comprehensive treatment of NAFLD.

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Bibliography:

1. Byrne CD, Targher G. NAFLD: a multisystem disease. J Hepatol. 2015;62(1):S47-64. DOI: 10.1016/j.jhep.2014.12.012.
2. Gudan A, Kozłowska-Petriczko K, Wunsch E, Bodnarczuk T, Stachowska E. Small Intestinal Bacterial Overgrowth and Non-Alcoholic Fatty Liver Disease: What Do We Know in 2023? Nutrients. 2023;15(6):1323. DOI: 10.3390/nu15061323.
3. Gudan A, Jamioł-Milc D, Hawryłkowicz V, Skonieczna-Żydecka K, Stachowska E. The Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Non-Alcoholic Liver Diseases: NAFLD, NASH, Fibrosis, Cirrhosis-A Systematic Review, Meta-Analysis and MetaRegression. Nutrients. 2022;14(24):5261. DOI: 10.3390/nu14245261.
4. Shi H, Mao L, Wang L, Quan X, Xu X, Cheng Y, et al. Small intestinal bacterial overgrowth and orocecal transit time in patients of nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2021;33(1):e535-e539. DOI: 10.1097/MEG.0000000000002157.
5. Kuang L, Zhou W, Jiang Y. Association of small intestinal bacterial overgrowth with nonalcoholic fatty liver disease in children: A metaanalysis. PLoS One. 2021;16(12):e0260479. DOI: 10.1371/journal.pone.0260479.
6. Ferolla SM, Armiliato GN, Couto CA, Ferrari TC. The role of intestinal bacteria overgrowth in obesity-related nonalcoholic fatty liver disease. Nutrients. 2014;6(12):5583-99. DOI: 10.3390/nu6125583.
7. Sharpton SR, Oh TG, Madamba E, Wang C, Yu RT, Atkins AR, et al. Gut metagenome-derived signature predicts hepatic decompensation and mortality in NAFLD-related cirrhosis. Aliment Pharmacol Ther. 2022;56(10):1475-1485. DOI: 10.1111/apt.17236.
8. Cobbold JFL, Atkinson S, Marchesi JR, Smith A, Wai SN, Stove J, et al. Rifaximin in non-alcoholic steatohepatitis: An open-label pilot study. Hepatol Res. 2018;48(1):69-77. DOI: 10.1111/hepr.12904.
9. Gangarapu V, Ince AT, Baysal B, Kayar Y, Kılıç U, Gök Ö, et al. Efficacy of rifaximin on circulating endotoxins and cytokines in patients with nonalcoholic fatty liver disease. Eur J Gastroenterol Hepatol. 2015;27(7):840-5. DOI: 10.1097/MEG.0000000000000348.
10. Koch M. Gut microbiota and the liver: A tale of 2 cities: A narrative view in 2 acts. J Clin Gastroenterol. 2016;50(2):S183-S187. DOI: 10.1097/MCG.0000000000000699.

Publication of the article:

«Bulletin of problems biology and medicine», 2024 Issue 4, 175, 371-380 pages, index UDC 616.36-003.826:616.34-008.87]-085.331

DOI:

10.29254/2077-4214-2024-4-175-371-380