Hepatogastroenterology Unit, 1st Department of Medicine - Propaedeutic, Medical School, Athens University, Laiko General Hospital, Athens.
BACKGROUND AND AIM:
Cirrhotic patients are predisposed to intestinal bacterial overgrowth with translocation of bacterial products which may deteriorate liver haemodynamics. Having shown that short-term administration of rifaximin improves liver haemodynamics in decompensated cirrhosis, we conducted this study to investigate the effect of intestinal decontamination with rifaximin on the long-term prognosis of patients with alcohol-related decompensated cirrhosis (Child-Pugh >7) and ascites.
Patients who had received rifaximin and showed improved liver haemodynamics were enrolled in the current study and continued to receive rifaximin (1200 mg/d). Each patient was matched by age, sex and Child-Pugh grade to two controls and followed-up for up to 5 years, death or liver transplantation. Survival and risk of developing portal hypertension-related complications were compared between rifaximin group and controls.
Twenty three patients fulfilled the inclusion criteria and matched with 46 controls. Patients who received rifaximin had a significant lower risk of developing variceal bleeding (35% vs. 59.5%, p=0.011), hepatic encephalopathy (31.5% vs. 47%, p=0.034), spontaneous bacterial peritonitis (4.5% vs. 46%, p=0.027) and hepatorenal syndrome (4.5% vs. 51%, p=0.037) than controls. Five-year cumulative probability of survival was significantly higher in patients receiving rifaximin than in controls (61% vs. 13.5%, p=0.012). In the multivariate analysis, rifaximin administration was independently associated with lower risk of developing variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, and higher survival.
In patients with alcohol-related decompensated cirrhosis, long-term rifaximin administration is associated with reduced risk of developing complications of portal hypertension and improved survival.