title: Effect of rifaximin on gut microbiota composition in advanced liver disease and its complications.
abstract: Liver cirrhosis is a paradigm of intestinal dysbiosis. The qualitative and quantitative derangement of intestinal microbial community reported in cirrhotic patients seems to be strictly related with the impairment of liver function. A kind of gut microbial "fingerprint", characterized by the reduced ratio of "good" to "potentially pathogenic" bacteria has recently been outlined, and is associated with the increase in Model for End-Stage Liver Disease and Child Pugh scores. Moreover, in patients presenting with cirrhosis complications such as spontaneous bacterial peritonitis (SBP), hepatic encephalopathy (HE), and, portal hypertension intestinal microbiota modifications or the isolation of bacteria deriving from the gut are commonly reported. Rifaximin is a non-absorbable antibiotic used in the management of several gastrointestinal diseases. Beyond bactericidal/bacteriostatic, immune-modulating and anti-inflammatory activity, a little is known about its interaction with gut microbial environment. Rifaximin has been demonstrated to exert beneficial effects on cognitive function in patients with HE, and also to prevent the development of SBP, to reduce endotoxemia and to improve hemodynamics in cirrhotics. These results are linked to a shift in gut microbes functionality, triggering the production of favorable metabolites. The low incidence of drug-related adverse events due to the small amount of circulating drug makes rifaximin a relatively safe antibiotic for the modulation of gut microbiota in advanced liver disease.
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Ponziani
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Gerardi
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Pecere
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: D'Aversa
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Loris
authors.initials: L
authors.lastname: Lopetuso
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Maria Assunta
authors.initials: MA
authors.lastname: Zocco
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Pompili
authors.affiliation: Francesca Romana Ponziani, Viviana Gerardi, Silvia Pecere, Francesca D'Aversa, Loris Lopetuso, Maria Assunta Zocco, Maurizio Pompili, Antonio Gasbarrini, Internal Medicine and Gastroenterology, Agostino Gemelli Hospital, 00168 Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
mesh_terms: D000818:Animals; D000890:Anti-Infective Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001419:Bacteria / Q000145:classification / Q000187:drug effects* / Q000254:growth & development; D064806:Dysbiosis; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D006801:Humans; D007422:Intestines / Q000187:drug effects* / Q000382:microbiology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D012294:Rifamycins / Q000009:adverse effects / Q000627:therapeutic use*; D000078262:Rifaximin; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D005765:Gastrointestinal Agents; D012294:Rifamycins; D000078262:Rifaximin
keywords: Ascites; Endotoxemia; Gut microbiota; Hepatic encephalopathy; Liver cirrhosis; Rifaximin; Spontaneous bacterial peritonitis; Thrombocytopenia