title: Review article: potential mechanisms of action of rifaximin in the management of hepatic encephalopathy and other complications of cirrhosis.
abstract: BACKGROUND
  Progressive gut milieu (microbiota) changes occur in patients with cirrhosis and are associated with complications [e.g. hepatic encephalopathy (HE)].
  
  
  OBJECTIVE
  To examine the role of rifaximin in the management of HE and other complications of cirrhosis, including potential mechanisms of action and the need for future studies.
  
  
  METHODS
  A literature search was conducted using the keywords 'rifaximin', 'hepatic encephalopathy', 'ascites', 'variceal bleeding', 'peritonitis', 'portal hypertension', 'portopulmonary hypertension' and 'hepatorenal syndrome'.
  
  
  RESULTS
  The nonsystemic agent rifaximin reduces the risk of HE recurrence and HE-related hospitalisations in cirrhosis. In patients with cirrhosis, rifaximin modulates the bacterial composition of the gut microbiota without a consistent effect on overall faecal microbiota composition. However, rifaximin can impact the function or activities of the gut microbiota. For example, rifaximin significantly increased serum levels of long-chain fatty acids and carbohydrate metabolism intermediates in patients with minimal HE. Rifaximin also favourably affects serum proinflammatory cytokine and faecal secondary bile acid levels.
  
  
  CONCLUSIONS
  The gut microenvironment and associated microbiota play an important role in the pathogenesis of HE and other cirrhosis-related complications. Rifaximin's clinical activity may be attributed to effects on metabolic function of the gut microbiota, rather than a change in the relative bacterial abundance.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Bajaj
mesh_terms: D001201:Ascites / Q000150:complications / Q000188:drug therapy; D019468:Disease Management; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000188:drug therapy; D006471:Gastrointestinal Hemorrhage / Q000150:complications / Q000188:drug therapy; D000069196:Gastrointestinal Microbiome / Q000187:drug effects*; D006501:Hepatic Encephalopathy / Q000150:complications / Q000188:drug therapy*; D006530:Hepatorenal Syndrome / Q000150:complications / Q000188:drug therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000150:complications*; D008107:Liver Diseases / Q000150:complications / Q000188:drug therapy*; D010538:Peritonitis / Q000150:complications / Q000188:drug therapy; D012008:Recurrence; D012294:Rifamycins / Q000494:pharmacology* / Q000627:therapeutic use*; D000078262:Rifaximin
chemical_list: D012294:Rifamycins; D000078262:Rifaximin