Efficacy of combined prophylactic therapy (rifaximine alpha + prebiotic arabinogalactan with lactofferin) on GUT function in patients with diagnosed symptomatic uncomplicated diverticular disease.

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Microbiota and the gut-liver axis: bacterial translocation, inflammation and infection in cirrhosis.

Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota. In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic bacteria (i.e., gram negative species) and a decrease in autochthonous familiae. Here we summarize the available literature on the risk of gut dysbiosis in liver cirrhosis and its clinical consequences. We therefore described the features of the complex interaction between gut microbiota and cirrhotic host, the so called "gut-liver axis", with a particular attention to the acquired risk of bacterial translocation, systemic inflammation and the relationship with systemic infections in the cirrhotic patient. Such knowledge might help to develop novel and innovative strategies for the prevention and therapy of gut dysbiosis and its complication in liver cirrhosis.

Infección por Clostridium difficile tratada satisfactoriamente con rifaximine / Clostridium difficile infection successfully treated with rifaximine

Resumen La infección por Clostridium difficile (cd) es una de la causas más comunes de diarrea adquirida en el ámbito hospitalario, y su espectro clínico puede ir desde casos leves, autolimitados, hasta situaciones como colitis de muy difícil manejo que pueden poner en riesgo la vida del paciente (1). Generalmente se ha asociado al uso crónico de antibióticos de amplio espectro (2). La incidencia de la enfermedad ha aumentado en los últimos años, haciendo que aparezcan nuevas opciones terapéuticas y diagnósticas a las ya conocidas. El objetivo de este artículo es hacer la revisión de un caso de un paciente con infección por cd documentada de difícil manejo, que respondió satisfactoriamente al manejo con rifaximine. (ActaMed Colomb 2013; 38: 177-181).

Abstract Infection with Clostridium difficile (CD) is one of the most common causes of diarrhea acquired in the hospital, and its clinical spectrum can range from mild, self-limiting cases to situations like colitis with difficult management that can put at risk the life of the patient (1). It has been generally associated with chronic use of broad spectrum antibiotics (2). the incidence of the disease has increased in recent years, causing the emergence of new therapeutic and diagnostic options different to those already known. the aim of this article is to review the case of a patient with documented cd infection with difficult management, that responded successfully to treatment with rifaximine. (Acta Med Colomb 2013; 38: 177-181).

Sobrecrecimiento bacteriano intestinal / Small intestinal bacterial overgrowth

El sobrecrecimiento bacteriano intestinal (SBI) es una condición causada por un número anormal de bacterias en el intestino delgado. Se le define como la presencia de más de 105 UFC/ ml de bacterias de tipo colónico a nivel del intestino delgado. Los principales factores que restringen la colonización bacteriana en el intestino delgado son la barrera ácida gástrica, la inmunidad mucosa y sistémica y la motilidad intestinal. Cuando estos factores fallan se desarrolla SBI. Los principales factores asociados a la presencia de esta condición son: aclorhidria o hipoclorhidria, edad avanzada, cirugías, cirrosis hepática, diabetes mellitus, diversas enfermedades inmunológicas y ausencia del receptor farsenoide X. Existe controversia acerca de su asociación con trastornos funcionales digestivos, especialmente con síndrome de intestino irritable. Se le considera como un síndrome de malabsorción aunque sus manifestaciones clínicas son variables de un sujeto a otro. Los principales síntomas son la presencia de diarrea, esteatorrea, dolor abdominal crónico, distensión abdominal y flatulencia. El estándar de oro para su diagnóstico es el aspirado y cultivo de fluido del intestino delgado. Dado que es un test invasivo suelen utilizarse para su diagnóstico los test de aire espirado, con glucosa y lactulosa. Su tratamiento implica solucionar la condición predisponente cuando es posible, y administrar antibióticos de amplio espectro, metronidazol, ciprofloxacino y la rifaximina (por 10 días) son los más utilizados. Dada su elevada tasa de recurrencia debe valuarse la posibilidad de terapia cíclica. El uso de probióticos está en estudio.

Small intestinal bacterial overgrowth (SIBO) is a clinical condition caused by an increased level of bacteria in the small intestine. It is defined as the presence of more than 10ª elevate a 5 CFU/ml of colonic type bacteria within the small intestine. The main factors that prevent bacterial colonization in the small intestine are gastric acid, mucosal and systemic immunity, and intestinal motility. When one or more of these mechanisms fail, SIBO can occur. The main predisposing factors for SIBO are: achlorhydria or hypochlorhydria, old age, surgeries, liver cirrhosis, diabetes mellitus, different immunological diseases and the absence of the farsenoid X receptor. The association with functional gastrointestinal diseases, particularly irritable bowel syndrome, is controversial. SIBO is generally considered a malabsorption syndrome; although clinical manifestations can be largely different in each subject. Common symptoms are diarrhea steatorrhea, chronic abdominal pain, bloating and flatulence. The culture of jejunal aspirate is considered the gold standard diagnostic test, however, due to the fact that it is an invasive test, glucose and lactulose breath tests are currently used in clinical practice. SIBO therapy is based on treatment of predisposing condition, whenever possible, and the administration of wide-spectrum antibiotics. Metronidazole, ciprofloxacin and rifaximin (10 days) are the most frecuently used antibiotics in clinical practice. SIBO recurrence is high, and future trials are needed to assess the usefullness of cyclic courses of antibiotics. The use of probiotic sis being studied.