title: Long-term administration of rifaximin improves the prognosis of patients with decompensated alcoholic cirrhosis.
abstract: OBJECTIVE
  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 (Child-Pugh > 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 Child-Pugh 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.
authors.affiliation: Hepatogastroenterology Unit, 1st Department of Medicine-Propaedeutic, Medical School, Athens University, Laiko General Hospital, Athens, Greece. jvlachog@hotmail.com
authors.forename: Jiannis
authors.initials: J
authors.lastname: Vlachogiannakos
authors.forename: Nikos
authors.initials: N
authors.lastname: Viazis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Vasianopoulou
authors.forename: Irene
authors.initials: I
authors.lastname: Vafiadis
authors.forename: Dimitrios G
authors.initials: DG
authors.lastname: Karamanolis
authors.forename: Spiros D
authors.initials: SD
authors.lastname: Ladas
mesh_terms: D000368:Aged; D004334:Drug Administration Schedule; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000517:prevention & control; D006530:Hepatorenal Syndrome / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006975:Hypertension, Portal / Q000188:drug therapy* / Q000209:etiology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin