The role of small intestinal bacterial overgrowth in cystic fibrosis: a randomized case-controlled clinical trial with rifaximin

摘要

BackgroundScientific literature shows a high prevalence of Small Intestinal Bacterial Overgrowth (SIBO) in patients with Cystic Fibrosis (CF). The role of SIBO in nutritional status and gastrointestinal symptoms in CF is not known. Our aim was to study epidemiology and clinical impact of SIBO while assessing the efficacy of rifaximin in eradicating SIBO in CF patients.MethodsSymptoms questionnaire and Glucose Breath Test (GBT) were given to 79 CF patients (median age 19.6years; 9.2-36.9). Subjects with a positive GBT were enrolled in a randomized controlled trial and received rifaximin 1200mg for 14days or no treatment. Questionnaire and GBT were repeated 1month after the end of treatment or 45days after the first negative GBT.ResultsOut of 79 patients, 25 were affected by SIBO (31.6%) with a significant correlation with lower BMI, SDS-BMI (p0.05) and serum albumin levels (p0.05), independently from pancreas insufficiency. Twenty-three patients took part in the randomized trial, 13 patients (56.5%) in rifaximin group and 10 patients (43.5%) in control group. Eradication rate of SIBO was 9/10 (90%) in rifaximin group and 2/6 (33.3%) in control group (p0.05). In the rifaximin group, gastrointestinal symptom improvement was observed in 4/5 patients aged14years and in 0/5 patients aged14years (p0.05); in 2/6 patients in the control group.ConclusionsCF patients show a high prevalence of SIBO, related to a poorer nutritional status. Rifaximin therapy is well tolerated and the results are promising in terms of efficacy in eradicating small intestinal bacterial overgrowth in CF.