The intriguing role of Rifaximin in gut barrier chronic inflammation and in the treatment of Crohn’s disease

ABSTRACT

Introduction: The gastrointestinal tract acts as a functional unit organized as a semipermeable multilayer system, in which commensal gut microbiota represents the anatomical barrier. Recently, several studies have highlighted the involvement of gut microbiota in inflammatory bowel diseases (IBD) pathogenesis, in sustaining gut barrier chronic inflammation, and in conditioning disease course and therapeutical response. This evidence provides a rationale for treating patients with gut microbiota modifiers. Among these, Rifaximin represents a non-traditional antibiotic able to act as a ‘eubiotic’ on intestinal barrier.

Area covered: The purpose of this narrative review is to explore the impact of Rifaximin on gut barrier and gut microbiota in IBD, in particular in Crohn’s disease (CD), and to analyze its potential therapeutic applications.

Expert opinion: The possibility of a beneficial activity of Rifaximin in chronic intestinal inflammation and CD has been debated and evaluated with different studies having obtained promising but still preliminary data. Larger trials are therefore needed. This gut-specific antibiotic could represent an alternative to systemic antibiotics thanks to its favorable safety profile and promising efficacy data. Rifaximin could exert, when appropriate, a synergic effect with immunomodulators in IBD, acting on both the microbial and the immunological sides of gut barrier impairment.

KEYWORDS:

• Rifaximin
• gut microbiota
• gut barrier
• chronic inflammation
• Crohn’s disease
• inflammatory bowel disease
• IBD

Article highlights

• IBD are characterized by challenging gut microbiota modifications with an abnormal immune response in genetically susceptible individuals.

• These evidences provide a rationale for treating patients with gut microbiota modifiers.

• Rifaximin is able to act as an ‘eubiotic’ on all the components of the intestinal barrier by exerting an anti-inflammatory activity, modulating the gut microbiota composition, altering the bacterial virulence, and inhibiting their adherence to the mucosa, their internalization and translocation into the systemic circulation.

• The possibility of a beneficial activity of Rifaximin in CD has been debated and evaluated with different studies that have obtained promising but still preliminary data.

• When appropriate, Rifaximin could exert a synergic effect with immunomodulators in IBD, acting on both the microbial and the immunological sides of gut barrier impairment.

New analyses will have to identify the best cluster of patients that could obtain an increased benefit from its ability to modulate gut barrier.

This box summarizes key points contained in the article.

Declaration of Interests

The authors acknowledge continued support from the Crohn’s & Colitis Foundation of America Research Fellowship Award (to LRL) and Società Italiana di Medicina Interna Premio di Ricerca (to LRL). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded