Antibiotic treatment of constipation-predominant irritable bowel syndrome

Mark Pimentel, Christopher Chang, Kathleen Shari Chua, James Mirocha, John DiBaise, Satish Rao, Meridythe Amichai

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Background: The antibiotic rifaximin is used to treat non-constipated irritable bowel syndrome (IBS). Methane production is associated with constipation and its severity in constipation-predominant IBS (C-IBS). A previous retrospective study suggested that rifaximin and neomycin was superior to neomycin alone in improving symptoms in methane-positive subjects. Aims: To determine the effectiveness of neomycin alone or with rifaximin in improving symptoms in methane-positive C-IBS subjects. Methods: A double-blind, randomized, placebo-controlled trial was performed from 2010 to 2013 at three tertiary care centers. Subjects aged 18-65 with C-IBS (Rome II criteria) and breath methane (>3 ppm) meeting the inclusion and exclusion criteria were recruited. Subjects completed a baseline symptom questionnaire rating the severity of abdominal and bowel symptoms on a visual analog scale and were randomized to receive neomycin and placebo or neomycin and rifaximin for 14 days. Symptom severity was assessed by weekly questionnaire for 2 weeks of therapy and 4 additional weeks of follow-up. Results: Thirty-one subjects (16 neomycin and placebo, 15 neomycin and rifaximin) were included in the intention-to-treat analysis. Constipation severity was significantly lower in the neomycin and rifaximin group (28.6 ± 30.8) compared to neomycin alone (61.2 ± 24.1) (P = 0.0042), with greater improvement in constipation (P = 0.007), straining (P = 0.017) and bloating (P = 0.020), but not abdominal pain. In the neomycin and rifaximin group, subjects with methane <3 ppm after treatment reported significantly lower constipation severity (30.5 ± 21.8) than subjects with persistent methane (67.2 ± 32.1) (P = 0.020). Conclusions: Rifaximin plus neomycin is superior to neomycin alone in improving multiple C-IBS symptoms. This effect is predicted by a reduction in breath methane.

Original languageEnglish (US)
Pages (from-to)1278-1285
Number of pages8
JournalDigestive Diseases and Sciences
Volume59
Issue number6
DOIs
Publication statusPublished - Jun 2014

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Keywords

  • Antibiotics
  • Breath methane
  • Constipation
  • Irritable bowel syndrome

ASJC Scopus subject areas

  • Physiology
  • Gastroenterology

Cite this

Pimentel, M., Chang, C., Chua, K. S., Mirocha, J., DiBaise, J., Rao, S., & Amichai, M. (2014). Antibiotic treatment of constipation-predominant irritable bowel syndrome. Digestive Diseases and Sciences, 59(6), 1278-1285. https://doi.org/10.1007/s10620-014-3157-8