Game Changers in Gastroenterology: 2011

David A. Johnson, MD


November 23, 2011

In This Article

Rifaximin Therapy for Patients With Irritable Bowel Syndrome Without Constipation

Pimentel M, Lembo A, Chey WD; TARGET Study Group, et al.
N Engl J Med. 2011;364:22-32.

This report described 2 identically designed, phase 3, double-blind, placebo-controlled trials. Patients who had irritable bowel syndrome (IBS) without constipation were randomly assigned to either rifaximin at a dose of 550 mg or placebo, 3 times daily for 2 weeks, and followed for an additional 10 weeks. More patients in the rifaximin group had relief from the primary endpoint of global IBS symptoms (40.7% vs 31.7%, P < .001) as well as relief from bloating (40.2% vs 30.3%, P <.001). In addition, significantly more patients in the rifaximin group had a response to treatment as assessed by daily ratings of IBS symptoms, bloating, abdominal pain, and stool consistency. The incidence of adverse events was similar in the 2 groups.

Why Is This a Game Changer?

This study suggests an infectious etiology -- at least for some patients with diarrhea and IBS. The treatment of small intestinal overgrowth raises an entirely new perspective for a subset of patients with IBS.


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