Digestive Diseases and Sciences

, 56:2939

Double-Blind Randomized Controlled Trial of Rifaximin for Persistent Symptoms in Patients with Celiac Disease

  • Matthew S. Chang
  • Maria T. Minaya
  • Jianfeng Cheng
  • Bradley A. Connor
  • Suzanne K. Lewis
  • Peter H. R. Green
Original Article

DOI: 10.1007/s10620-011-1719-6

Cite this article as:
Chang, M.S., Minaya, M.T., Cheng, J. et al. Dig Dis Sci (2011) 56: 2939. doi:10.1007/s10620-011-1719-6

Abstract

Background

Small intestinal bacterial overgrowth (SIBO) is one cause of a poor response to a gluten-free diet (GFD) and persistent symptoms in celiac disease. Rifaximin has been reported to improve symptoms in non-controlled trials.

Aims

To determine the effect of rifaximin on gastrointestinal symptoms and lactulose-hydrogen breath tests in patients with poorly responsive celiac disease.

Methods

A single-center, double-blind, randomized, controlled trial of patients with biopsy-proven celiac disease and persistent gastrointestinal symptoms despite a GFD was conducted. Patients were randomized to placebo (n = 25) or rifaximin (n = 25) 1,200 mg daily for 10 days. They completed the Gastrointestinal Symptom Rating Scale (GSRS) and underwent lactulose-hydrogen breath tests at weeks 0, 2, and 12. An abnormal breath test was defined as: (1) a rise in hydrogen of ≥20 parts per million (ppm) within 100 min, or (2) two peaks ≥20 ppm over baseline.

Results

GSRS scores were unaffected by treatment with rifaximin, regardless of baseline breath tests. In a multivariable regression model, the duration of patients’ gastrointestinal symptoms significantly predicted their overall GSRS scores (estimate 0.029, p < 0.006). According to criteria 1 and 2, respectively, SIBO was present in 55 and 8% of patients at baseline, intermittently present in 28 and 20% given placebo, and 28 and 12% given rifaximin. There was no difference in the prevalence of SIBO between placebo and treatment groups at weeks 2 and 12.

Conclusions

Rifaximin does not improve patients’ reporting of gastrointestinal symptoms and hydrogen breath tests do not reliably identify who will respond to antibiotic therapy.

Keywords

Celiac disease Small intestine Clinical pharmacology Diarrhea Malabsorption Microbiology Symptom score or index 

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Matthew S. Chang
    • 1
  • Maria T. Minaya
    • 1
  • Jianfeng Cheng
    • 2
  • Bradley A. Connor
    • 3
  • Suzanne K. Lewis
    • 1
  • Peter H. R. Green
    • 1
  1. 1.Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of MedicineVirginia Commonwealth UniversityRichmondUSA
  3. 3.Department of MedicineWeill Medical College of Cornell UniversityNew YorkUSA

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