Abstract
Background and aimsAlcoholic hepatitis (AH) is characterized by acute liver failure, neurocognitive impairment and renal failure. Severe inflammatory reactions are also known to occur in AH. Inflammation and bacterial translocation in the gut are thought to have major impact on disease development and progression. The mortality rate for AH is close to 50%. We aimed to assess the efficacy of rifaximin in treating AH and its impact on inflammation and metabolism.MethodsThe trial was approved by relevant authorities (EudraCT no: 2014-02264-33, Scientific Ethics Committee, jr. no: H-1-2014-056). Primary outcomes were changes in metabolic and inflammatory markers. Secondary outcomes were portal hypertension, kidney and neurocognitive function.ResultsThirty-two patients were randomized to standard medical therapy (SMT) or SMT plus rifaximin, allocation was concealed. Four patients in the SMT group and five patients in the SMT + rifaximin group died due to AH and liver failure. No adverse events related to the study medication were observed. We found no significant differences in amino acids or inflammation markers (IL-2, IL-6, IL-8, IL-10, TNF-α, interferon-γ) between the groups after 28 and 90 days.ConclusionRifaximin does not alter inflammation or metabolism in patients with AH.
Highlights
Alcoholic hepatitis (AH) develops in response to a considerable intake of alcohol among people with a susceptibility to the disease
Thirty-two patients were randomized to standard medical therapy (SMT) or SMT plus rifaximin, allocation was concealed
We found no significant differences in amino acids or inflammation markers (IL-2, IL-6, IL-8, IL-10, Tumor necrosis factor-alpha (TNF-α), interferon-γ) between the groups after 28 and 90 days
Summary
Alcoholic hepatitis (AH) develops in response to a considerable intake of alcohol among people with a susceptibility to the disease. Bacterial translocation has been hypothesized as a key pathogenic driver of systemic inflammation in acute-on-chronic liver failure [7, 8]. In the presence of chronic liver disease, an increased permeability in the gut membrane causes translocation of bacteria and bacterial pathogens into the lymphatic and blood systems, activating inflammatory mediators in the liver [9]. This may be further aggravated by alcohol consumption, which in the intestinal mucosa leads to destruction of the epithelial tight junctions, increasing gut permeability and raising levels of endotoxins in the blood stream [10, 11]. Alcoholic hepatitis (AH) is characterized by acute liver failure, neurocognitive impairment and renal failure. We aimed to assess the efficacy of rifaximin in treating AH and its impact on inflammation and metabolism
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