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Modulation of the gut microbiota composition by rifaximin in non-constipated irritable bowel syndrome patients: a molecular approach

Authors Soldi S, Vasileiadis S, Uggeri F, Campanale MC, Morelli L, Fogli MV, Calanni F, Grimaldi M, Gasbarrini A

Received 6 June 2015

Accepted for publication 26 September 2015

Published 4 December 2015 Volume 2015:8 Pages 309—325

DOI https://doi.org/10.2147/CEG.S89999

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Yuji Naito

Peer reviewer comments 2

Editor who approved publication: Professor Andreas M Kaiser

Sara Soldi,1 Sotirios Vasileiadis,2 Francesca Uggeri,1 Mariachiara Campanale,3 Lorenzo Morelli,4 Maria Vittoria Fogli,5 Fiorella Calanni,5 Maria Grimaldi,5 Antonio Gasbarrini3

1AAT – Advanced Analytical Technologies Srl, Piacenza, Italy; 2Centre for Environmental Risk Assessment and Remediation, University of South Australia, Mawson Lakes, Australia; 3Internal Medicine and Gastroenterology Division, Catholic University of Rome, Rome, Italy; 4Microbiology Institute, Catholic University of Piacenza, Piacenza, Italy; 5Alfa Wassermann SpA, Bologna, Italy


Abstract: Rifaximin, with its low systemic absorption, may represent a treatment of choice for irritable bowel syndrome (IBS), mainly due to its ability to act on IBS pathogenesis, through the influence on gut microbiota. The aim of the present study was to assess, by biomolecular tools, the rifaximin active modulation exerted on gut microbiota of non-constipated IBS patients. Fifteen non-constipated IBS subjects were treated with 550 mg rifaximin three times a day for 14 days. Stool samples were collected before starting the treatment, at the end of it, and after a 6-week washout period. Real-time polymerase chain reaction, denaturing gradient gel electrophoresis, and next-generation sequencing were applied to all the samples to verify and quantify possible microbial fluctuations. Rifaximin treatment did not affect the overall composition of the microbiota of the treated subjects, inducing fluctuations in few bacterial groups, balanced by the replacement of homologs or complementary bacterial groups. Rifaximin appeared to influence mainly potentially detrimental bacteria, such as Clostridium, but increasing the presence of some species, such as Faecalibacterium prausnitzii. A decrease in the Firmicutes/Bacteroidetes ratio after 14 days of treatment and bacterial profiles with higher biodiversity were observed during the follow-up compared to baseline. Rifaximin treatment, although effective on IBS symptom relief and normalization of lactulose breath test, did not induce dramatic shifts in the microbiota composition of the subjects, stimulating microbial reorganization in some populations toward a more diverse composition. It was not possible to speculate on differences of fecal microbiota modification between responders vs nonresponders and to correlate the quali-/quantitative modification of upper gastrointestinal microbiota and clinical response.

Keywords: IBS, rifaximin, next-generation sequencing, microbiota

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