Ayesha Shah1,2,3,4,5, Saravana Ruban Gurusamy1,2, Teressa Hansen2, Gavin Callaghan2,6, Nicholas J Talley3,4,5,7, Natasha Koloski1,2,3,4,5,7,8, Marjorie M Walker3,4,5,7, Michael P Jones3,4,5,9, Mark Morrison1,3,4,5,10, Gerald J Holtmann11,12,13,14,15,16. 1. Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia. 2. Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Woolloongabba, QLD, Australia. 3. Australian Gastrointestinal Research Alliance, Brisbane, Australia. 4. Australian Gastrointestinal Research Alliance, Newcastle, Australia. 5. Australian Gastrointestinal Research Alliance, Sydney, Australia. 6. Department of Pharmacy, Princess Alexandra Hospital, Brisbane, QLD, Australia. 7. Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia. 8. Faculty of Health and Behavioural Sciences, University of Queensland, Herston, QLD, Australia. 9. Department of Psychology, Macquarie University, Sydney, NSW, Australia. 10. Faculty of Medicine, University of Queensland Diamantina Institute, Woolloongabba, QLD, Australia. 11. Faculty of Medicine, University of Queensland, St. Lucia, QLD, Australia. g.holtmann@uq.edu.au. 12. Department of Gastroenterology and Hepatology, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Woolloongabba, QLD, Australia. g.holtmann@uq.edu.au. 13. Australian Gastrointestinal Research Alliance, Brisbane, Australia. g.holtmann@uq.edu.au. 14. Australian Gastrointestinal Research Alliance, Newcastle, Australia. g.holtmann@uq.edu.au. 15. Australian Gastrointestinal Research Alliance, Sydney, Australia. g.holtmann@uq.edu.au. 16. Faculty of Health and Behavioural Sciences, University of Queensland, Herston, QLD, Australia. g.holtmann@uq.edu.au.
Abstract
BACKGROUND AND AIMS: Antimicrobial therapy improves symptoms in patients with irritable bowel syndrome (IBS), but the efficacy in functional dyspepsia (FD) is largely unknown. While FD and IBS frequently overlap, it is unknown if concomitant IBS in FD alters the response to antimicrobial therapy in FD. Thus, we aimed to assess and compare the effect of antimicrobial therapy on visceral sensory function and symptom improvement in FD patients with and without IBS. METHODS: Adult patients with FD with or without IBS received rifaximin 550 mg BD for 10 days, followed by a 6-week follow-up period. The total gastrointestinal symptom score as measured by the SAGIS (Structured Assessment of Gastrointestinal Symptoms) questionnaire and subscores (dyspepsia, diarrhea, and constipation), symptom response to a standardized nutrient challenge and normalization of the glucose breath tests were measured. RESULTS: Twenty-one consecutive adult patients with FD and 14/21 with concomitant IBS were recruited. Treatment with rifaximin resulted in a significant (p = 0.017) improvement in the total SAGIS score from 34.7 (± 15.4) at baseline to 26.0 (± 16.8) at 2 weeks and 25.6 (± 17.8) at 6 weeks post-treatment. Similarly, compared to baseline there was a statistically significant improvement in SAGIS subscores for dyspepsia and diarrhea (all p < 0.05) and effects persisted for 6 weeks post-treatment. Similarly, the symptom score (and subscores) following a standardized nutrient challenge improved significantly (p < 0.001) 2 weeks post-treatment. The presence of concomitant IBS did not significantly influence the improvement of symptoms after antibiotic therapy (all p > 0.5). CONCLUSIONS: In FD patients, the response to antimicrobial therapy with rifaximin is not influenced by concomitant IBS symptoms.
BACKGROUND AND AIMS: Antimicrobial therapy improves symptoms in patients with irritable bowel syndrome (IBS), but the efficacy in functional dyspepsia (FD) is largely unknown. While FD and IBS frequently overlap, it is unknown if concomitant IBS in FD alters the response to antimicrobial therapy in FD. Thus, we aimed to assess and compare the effect of antimicrobial therapy on visceral sensory function and symptom improvement in FD patients with and without IBS. METHODS: Adult patients with FD with or without IBS received rifaximin 550 mg BD for 10 days, followed by a 6-week follow-up period. The total gastrointestinal symptom score as measured by the SAGIS (Structured Assessment of Gastrointestinal Symptoms) questionnaire and subscores (dyspepsia, diarrhea, and constipation), symptom response to a standardized nutrient challenge and normalization of the glucose breath tests were measured. RESULTS: Twenty-one consecutive adult patients with FD and 14/21 with concomitant IBS were recruited. Treatment with rifaximin resulted in a significant (p = 0.017) improvement in the total SAGIS score from 34.7 (± 15.4) at baseline to 26.0 (± 16.8) at 2 weeks and 25.6 (± 17.8) at 6 weeks post-treatment. Similarly, compared to baseline there was a statistically significant improvement in SAGIS subscores for dyspepsia and diarrhea (all p < 0.05) and effects persisted for 6 weeks post-treatment. Similarly, the symptom score (and subscores) following a standardized nutrient challenge improved significantly (p < 0.001) 2 weeks post-treatment. The presence of concomitant IBS did not significantly influence the improvement of symptoms after antibiotic therapy (all p > 0.5). CONCLUSIONS: In FD patients, the response to antimicrobial therapy with rifaximin is not influenced by concomitant IBS symptoms.
Authors: Michael P Jones; Ayesha Shah; Marjorie M Walker; Natasha A Koloski; Gerald Holtmann; Nicholas J Talley Journal: United European Gastroenterol J Date: 2021-10-15 Impact factor: 4.623
Authors: Anupam Rej; Michael D E Potter; Nicholas J Talley; Ayesha Shah; Gerald Holtmann; David Surendran Sanders Journal: Am J Gastroenterol Date: 2022-04-08 Impact factor: 12.045
Authors: Uday C Ghoshal; Sanjeev Sachdeva; Ujjala Ghoshal; Asha Misra; Amarender Singh Puri; Nitesh Pratap; Ayesha Shah; M Masudur Rahman; Kok Ann Gwee; Victoria P Y Tan; Tahmeed Ahmed; Yeong Yeh Lee; B S Ramakrishna; Rupjyoti Talukdar; S V Rana; Saroj K Sinha; Minhu Chen; Nayoung Kim; Gerald Holtmann Journal: Indian J Gastroenterol Date: 2022-10-10