Rifaximin and Propranolol Combination Therapy Is More Effective than Propranolol Monotherapy for the Reduction of Portal Pressure: An Open Randomized Controlled Pilot Study

임유리; 김문영; 장윤옥; 백순구; 권상옥

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자료유형: 학술저널

저자정보: 임유리 김문영 장윤옥 백순구 권상옥

저널정보: 거트앤리버 발행위원회 Gut and Liver Gut and Liver 제11권 제5호

발행연도: 2017.1

수록면: 702 - 710 (9page)

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Background/Aims: Non-selective beta blockers (NSBBs) are currently the only accepted regimen for preventing portal hypertension (PHT)-related complications. However, the effect of NSBBs is insufficient in many cases. Bacterial translocation (BT) is one of the aggravating factors of PHT in cirrhosis; therefore, selective intestinal decontamination by rifaximin is a possible therapeutic option for improving PHT. We investigated whether the addition of rifaximin to propranolol therapy can improve hepatic venous pressure gradient (HVPG) response. Methods: Sixty-four cirrhosis patients were randomly assigned to propranolol monotherapy (n=48) versus rifaximin and propranolol combination therapy (n=16). Baseline and post-treatment HVPG values, BT-related markers (lipopolysaccharide [LPS], LPS-binding protein [LBP], interleukin-6 [IL-6], and tumor necrosis factor α [TNF-α]), serological data, and adverse event data were collected. HVPG response rate was the primary endpoint. Results: Combination therapy was associated with better HVPG response rates than monotherapy (56.2% vs 87.5%, p=0.034). In combination therapy, posttreatment BT-related markers were significantly decreased (LPS, p=0.005; LBP, p=0.005; IL-6, p=0.005; TNF-α, p=0.047). Conclusions: Rifaximin combination therapy showed an additive effect in improving PHT compared to propranolol monotherapy. These pilot data suggest that the addition of rifaximin to NSBBs could be a good therapeutic option for overcoming the limited effectiveness of NSBBs.

#Bacterial translocation #Rifaximin #Hypertension #portal #Hepatic venous pressure gradient

참고문헌 (38)

참고문헌 신청

Guarner C / 2005 / Bacterial translocation and its consequences in patients with cirrhosis / Eur J Gastroenterol Hepatol 17:27~31

Fukui H / 2015 / Gut-liver axis in liver cirrhosis: how to manage leaky gut and endotoxemia / World J Hepatol 7:425~442

Giannelli V / 2014 / Microbiota and the gutliver axis: bacterial translocation, inflammation and infection in cirrhosis / World J Gastroenterol 20:16795~16810

Rasaratnam B / 2003 / The effect of selective intestinal decontamination on the hyperdynamic circulatory state in cirrhosis: a randomized trial / Ann Intern Med 139:186~193

Fernández J / 2012 / Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study / Hepatology 55:1551~1561

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