Is Xifaxan (Rifaximin) helpful for chronic abdominal pain with intermittent small bowel obstructions and enteritis?

From the Guidelines

Xifaxan (rifaximin) may be beneficial for managing chronic abdominal pain associated with small bowel bacterial overgrowth in patients with intermittent small bowel obstructions and enteritis, as it can help reduce bacterial overgrowth and alleviate symptoms. The typical dosage for small intestinal bacterial overgrowth (SIBO) is 550 mg three times daily for 14 days, though some patients may require repeated courses or cyclical therapy, as suggested by the AGA clinical practice guideline on the pharmacological management of irritable bowel syndrome with diarrhea 1.

Key Considerations

• Rifaximin works by reducing bacterial overgrowth in the small intestine, which can develop when intestinal motility is compromised by conditions like partial obstructions or enteritis.
• The medication is minimally absorbed systemically, allowing it to work primarily in the gut with few systemic side effects.
• However, treating the underlying cause of obstructions (such as adhesions, strictures, or inflammatory conditions) is essential for long-term management.
• Before starting rifaximin, testing for bacterial overgrowth with breath tests may be helpful, and the medication should be used as part of a comprehensive treatment plan that addresses the primary causes of obstructions and inflammation.

Comprehensive Treatment Approach

• The treatment plan may include anti-inflammatory medications, dietary modifications, or surgical intervention when appropriate.
• It is crucial to address the underlying causes of obstructions and inflammation, as well as to manage symptoms and prevent complications.
• A multidisciplinary team approach, including gastroenterologists, surgeons, pain management specialists, and nutritionists, may be necessary to provide optimal care for patients with chronic small intestinal dysmotility 1.

Important Notes

• The diagnosis of chronic small intestinal dysmotility can be challenging, and a definitive diagnosis should only be made when there is clear evidence of a specific cause.
• The management of chronic small intestinal dysmotility requires a comprehensive approach that addresses the underlying causes of the condition, as well as the patient's symptoms and nutritional needs.

From the Research

Xifaxan for Chronic Abdominal Pain with Intermittent Small Bowel Obstructions and Enteritis

• Xifaxan (Rifaximin) has been studied for its efficacy in treating irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO) 2, 3, 4, 5.
• The medication has shown potential in reducing symptoms of IBS, such as bloating, flatulence, stool consistency, and abdominal pain 2, 4.
• Rifaximin has also been found to be effective in eradicating SIBO, with eradication rates ranging from 70.8% to 84% 3, 5.
• In terms of safety, rifaximin has been shown to have a favorable benefit-to-harm ratio and is not associated with the emergence of bacterial antibiotic resistance 2, 5.
• A recent study investigated the efficacy and safety of rifaximin in patients with chronic intestinal pseudo-obstruction (CIPO), which often co-occurs with SIBO, and found that rifaximin may be beneficial in alleviating SIBO and reducing small intestinal gas volume in SIBO-positive patients with CIPO 6.
• However, it is essential to note that the current evidence may not directly address the specific condition of chronic abdominal pain with intermittent small bowel obstructions and enteritis, and more research may be needed to fully understand the potential benefits of Xifaxan in this context.
• The available studies suggest that Xifaxan may be helpful in managing symptoms associated with IBS and SIBO, which could be related to the underlying condition of chronic abdominal pain with intermittent small bowel obstructions and enteritis 2, 3, 4, 6, 5.