META-ANALYSIS: LONG-TERM THERAPY WITH RIFAXIMIN IN UNCOMPLICATED DIVERTICULAR DISEASE

Marco Bianchi (1) , Virginia Festa (1) , Alessandra Moretti (1) , Antonio Ciaco (1) , Manuela Mangone (1) , Valentina Tornatore (1) , Angelo Dezi (1) , Roberto Luchetti (1) , Barbara de Pascalis (1) , Claudio Papi (1) , Maurizio Koch (1)

1 gastroenterology and Hepatology

Background: Diverticular disease of the colon is a common gastrointestinal disease. Although most patients remain asymptomatic for their whole life, about 20-25% present symptoms related to "diverticular disease". Several randomized trials verified efficacy of a poorly absorbed antibiotic, such as rifaximin-alfa(rifaximin), in soothing symptoms and preventing diverticulitis. Aim of this study is to evaluate the long-term efficacy administration of rifaximin plus fiber supplementation versus fiber supplementation alone, on symptoms and complications, in patient with symptomatic uncomplicated diverticular disease. Methods: Pertinent studies were selected from the Medline, and the Cochrane Library Databases, references from published articles and reviews. Conventional meta-analysis according to DerSimonian and Laird method was used for the pooling of the results. The outcomes were 1- year complete symptom relief, and 1- year complication incidence. The Rate Difference (RD, with 95% CI) and the Number Needed to Treat (NNT) were used as measure of the therapeutic effect on each outcome. Results: Four prospective randomized trials including 1660 patients were selected. The pooled RD for symptom relief was 29.0% (rifaximin vs control ; 95% CI 24.5 to 33.6%; P<0.0001; NNT= 3). The pooled RD for complication rate was -1.7% in favor of rifaximin (95% CI -3.2 to -0.1%; P =0.03; NNT= 59). When considering only acute diverticulitis, the pooled RD in the treatment group was -2% (95% CI -3.4 to -0.6%; P =0.0057; NNT= 50). Conclusions: in symptomatic uncomplicated diverticular disease, treatment with rifaximin plus fiber supplementation is effective in obtaining symptom relief and preventing complications at 1 year.

Mots clés: Medicine

Marco Bianchi, Virginia Festa, Alessandra Moretti, Antonio Ciaco, Manuela Mangone, et al.. META-ANALYSIS: LONG-TERM THERAPY WITH RIFAXIMIN IN UNCOMPLICATED DIVERTICULAR DISEASE. Alimentary Pharmacology and Therapeutics, 2011, 33 (8), pp.902. ⟨10.1111/j.1365-2036.2011.04606.x⟩. ⟨hal-00618501⟩