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Rifaximin in nonalcoholic fatty liver disease: hit multiple targets with a single shot

Ahmed Abdel-Razik1, Nasser Mousa1, Walaa Shabana1

  • 1Departments of Tropical Medicine.

European Journal of Gastroenterology & Hepatology
|August 11, 2018
PubMed
Abstract

Insights

Rifaximin significantly improved nonalcoholic steatohepatitis (NASH) by reducing endotoxin and inflammation markers. This antibiotic therapy offers a safe approach to managing NASH, improving insulin resistance and liver fat score.

Area of Science:

  • Hepatology
  • Gastroenterology
  • Pharmacology

Background:

  • Nonalcoholic fatty liver disease (NAFLD) pathogenesis involves insulin resistance, inflammation, and gut-derived endotoxins.
  • Rifaximin, a poorly absorbed antibiotic, targets gut bacteria and may influence NAFLD progression.

Purpose of the Study:

  • To investigate the efficacy and safety of rifaximin in treating nonalcoholic steatohepatitis (NASH).

Main Methods:

  • A multicentric, double-blind, randomized, placebo-controlled study involving 50 patients with biopsy-proven NASH.
  • Evaluated biomarkers including liver enzymes, lipid profile, endotoxin, insulin resistance (HOMA), inflammatory cytokines (TLR-4, IL-6, TNF-α), and cytokeratin-18 (CK-18) over 6 months.

Main Results:

  • Rifaximin therapy led to significant reductions in HOMA, liver enzymes, endotoxin, TLR-4, IL-6, TNF-α, and CK-18 (P<0.05).
  • No significant changes were observed in lipid profiles or BMI.
  • The placebo group showed no significant improvements in these parameters.

Conclusions:

  • Rifaximin therapy is effective and safe for modifying NASH.
  • It reduces serum endotoxin, improves insulin resistance, and decreases inflammatory markers and liver fat.
  • Rifaximin shows promise in managing NASH patients.

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