cleveland.com
Featured Physician :: Dr. Gerard Isenberg
Division of Gastroenterology and Liver Disease
An antibiotic may become the first new treatment in a decade for an extremely common, and sometimes debilitating, digestive disorder. The treatment provided long-lasting relief to patients with diarrhea-predominant irritable bowel syndrome (IBS) in a large clinical trial completed at Cedars Sinai Medical Center in Los Angeles.
The results, published Wednesday in the New England Journal of Medicine, provide solid support for the theory that the symptoms of this difficult-to-treat illness are sometimes caused by excess bacteria in the small intestine.
IBS is a disorder of the lower intestinal tract that causes pain, bloating, nausea, diarrhea and constipation. It affects up to 20 percent of the population, making it one of the most commonly diagnosed disorders, according to the National Institutes of Health.
The treatment, an oral antibiotic called rifaximin, would be the first medication for patients with diarrhea-predominant IBS in more than 10 years if approved by the FDA. The drug is set for review in IBS patients in March.
It may be a boon for a vast number of patients.
Pimentel’s research has shown that between 30 percent and 80 percent of IBS patients, particularly those who suffer primarily from diarrhea, may have bacterial overgrowth and would benefit from rifaximin.
In the current study, a group of more than 1,200 diarrhea-predominant IBS patients gained significant relief from their symptoms — including bloating, pain and diarrhea — from the antibiotic, compared to a placebo.
Rifaximin is different than other antibiotics because it is minimally absorbed and mainly stays in the intestines, reducing side effects, said Pimentel. Symptom relief continued for 10 weeks of follow-up after the initial two-week dose of medication.
Dr. Gerard Isenberg, associate chief of the Division of Gastroenterology and Liver Disease at University Hospitals Case Medical Center, has used the therapy on his patients for the past two years as an off-label use. The drug is approved for the treatment of traveler’s diarrhea.
Many have shown dramatic improvement and seen few side effects, he says. “What’s hard about IBS is that it’s usually life-long, and you’re confronted with the question of whether you can repeat treatments of an antibiotic.”
