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Antibiotic Rifaximin (Xifaxan) Might Be Treatment Of Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome is characterized by a combination of abdominal pain and altered bowel function. There are many possible causes. For instance, there may be a disturbance in the muscle movement of the intestine or a lower tolerance for stretching and movement of the intestine. There is no abnormality in the structure of the intestine.It is mainly characterized by a pattern of symptoms that is often worsened by emotional stress. The condition involves hypersensitivity to pain in the gut, combined with altered bowel habits resulting in diarrhea, constipation, or both.

Irritable bowel syndrome (IBS) can occur at any age, but often begins in adolescence or early adulthood. It is more common in women. Predisposing factors may include a low-fiber diet, emotional stress, use of laxatives, a bout of infectious diarrhea, or other temporary bowel inflammation.Up to one in five American adults has irritable bowel syndrome. The disorder accounts for more than one out of every 10 doctor visits. For most people, signs and symptoms of irritable bowel disease are mild. Only a small percentage of people with irritable bowel syndrome have severe signs and symptoms.

Fortunately, unlike more serious intestinal diseases such as ulcerative colitis and Crohn's disease, irritable bowel syndrome doesn't cause inflammation or changes in bowel tissue or increase your risk of colorectal cancer. In many cases, you can control irritable bowel syndrome by managing your diet, lifestyle and stress.

Because it's still not clear what causes irritable bowel syndrome, treatment focuses on the relief of symptoms so that you can live your life as fully and normally as possible.In most cases, you can successfully control mild symptoms of irritable bowel syndrome by learning to manage stress and making changes in your diet and lifestyle. But if your problems are moderate or severe, you may need more help than lifestyle changes alone can offer.In many cases, simple changes in your diet and lifestyle can provide relief from irritable bowel syndrome. Although your body may not respond immediately to these changes, your goal is to find long-term, not temporary, solutions:

Treatment with the antibiotic rifaximin for 10 days can improve the symptoms of irritable bowel syndrome (IBS) for up to 10 weeks, the findings from a small study suggest.

Rifaximin is also sold in the United States under the trade name Xifaxan, and has been approved by the Food and Drug Administration for treatment of traveler's diarrhea caused by E. coli bacteria.

Previous reports have suggested that alterations in the micro-organisms normally found in the gastrointestinal system, primarily the overgrowth of bacteria, may contribute to irritable bowel syndrome. Therefore, treatment with agents that modify the microbial balance might affect disease outcomes, Dr. Mark Pimentel, from the Cedars-Sinai Medical Center in Los Angeles, and colleagues note in the Annals of Internal Medicine.

Neomycin, another antibiotic, has proven useful in reducing IBS symptoms, but the elimination rate of bacterial overgrowth with this treatment is just 25 percent. By contrast, rifaximin has broad-spectrum activity and can achieve elimination rates as high as 70 percent.

The present study involved 87 patients with IBS who were randomly assigned to receive rifaximin or placebo three times daily for 10 days. In addition to completing IBS-related questionnaires before and 7 days after treatment, the subjects kept weekly symptom diaries for 10 weeks.

Patients treated with rifaximin experienced significantly greater improvements in IBS symptoms than did patients assigned to the placebo. This was primarily related to a decline in bloating because no major differences were noted between the two treatment groups for abdominal pain, diarrhea or constipation.

Rifaximin was generally well-tolerated and was associated with only rare, minor side effects, which occurred with similar frequency in the placebo group.

"The clinical challenge is to identify the subset of patients with IBS who are most likely to have bacterial overgrowth that produces symptoms relative to the many other factors contributing to patients' clinical state," Dr. Douglas A. Drossman, from the University of North Carolina at Chapel Hill, comments in a related editorial.

"Pimentel and colleagues should be congratulated for their efforts to increase awareness of this important subgroup of patients with IBS symptoms who need to be identified and treated. However, until better evidence is available, decisions relating to diagnosis and treatment remain within the 'art' of medicine," he adds.