the combination of rifaximin with partially.pdf

Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth M. Furnari, A. Parodi, L. Gemignani, E. G. Giannini, S. Marenco, E. Savarino, L. Assandri, V. Fazio, D. Bonfanti, S. Inferrera V. Savarino Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy. Correspondence to: Prof. V. Savarino, Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Viale Benedetto XV, No. 6, Genoa, Liguria 16132, Italy. E-mail: vsavarin@unige.it Publication data Submitted 26 May 2010 First decision 10 June 2010 Resubmitted 20 July 2010 Accepted 27 July 2010 EV Pub Online 18 August 2010 SUMMARY Background Abnormal intestinal clearance is involved in the pathogenesis of small intes- tinal bacterial overgrowth (SIBO). It is known that partially hydrolysed guar gum affects intestinal motility. Eradication therapy of SIBO is based on antibiotic treatment: no data are available on the role of fibre supplementa- tion in eradicating SIBO. Aim To assess whether the combination of partially hydrolysed guar gum and rifaximin is more effective than rifaximin alone in the treatment of SIBO. Methods A 50 g-glucose breath test was given to 500 consecutive patients. Patients with a positive glucose breath test and predisposing conditions to SIBO entered into the study, and were randomized to receive rifaximin 1200 mg ?day or rifaximin 1200 mg ?day plus partially hydrolysed guar gum 5 g ?day for 10 days. Patients completed a symptom questionnaire and glu- cose breath test both in basal condition and 1 month after withdrawal of therapy. Results Seventy-seven patients had SIBO. Eradication rate of SIBO was 62.1% in the rifaximin group (both on per-protocol and intention-to-treat analyses), and 87.1% (per-protocol, P = 0.017) and 85.0% (intention-to-treat, P = 0.036) in the rifaximin-plus-partially hydrolysed guar gum group. Clinical impr