Rifaximin for the treatment of diarrhea-predominant irritable bowel syndrome

John SK1, Alexander CF2. Expert Rev Gastroenterol Hepatol. 2016 Jan 12. [Epub ahead of print]
Author information

1a Academic Clinical Fellow and Specialist Registrar, Leeds Gastroenterology Institute, St James's University Hospital , LS9 7TF , Leeds , UK. 2b Associate Professor and Honorary Consultant Gastroenterologist, Leeds Gastroenterology Institute , St James's University Hospital , LS9 7TF , Leeds , UK.


Irritable bowel syndrome (IBS) is a chronic, functional bowel disorder characterized by abdominal pain or discomfort and altered bowel habit. The pathophysiology is unclear, but may include altered gut motility, visceral hypersensitivity, abnormal central pain processing, chronic low-grade intestinal inflammation, or disturbances in the gut microbiome. These etiological mechanisms, alongside environmental factors such as stress and anxiety, vary between individuals and represent potential targets for treatment. Rifaximin is a poorly absorbed oral antibiotic proposed to act on the gut microenvironment, used in the treatment of travelers' diarrhea and hepatic encephalopathy. Clinical trials suggest the drug can reduce global IBS symptoms and improve bloating, abdominal pain, and stool consistency in some patients with non-constipated IBS, leading to Food and Drug Administration approval in the United States. This article considers the pharmacology of rifaximin, the evidence for its use in IBS, and the safety and tolerability of the drug.

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