Efficacy of long term cyclic administration of the poorly absorbed antibiotic Rifaximin in symptomatic,uncomplicated colonic diverticular disease

AIM： To comparatively evaluate the long term efficacy of Rifaximin and dietary fibers in reducing symptoms and/or complication frequency in symptomatic, uncomplicated diverticular disease,METHODS： 307 patients （118 males, 189 females, age range： 40-80 years） were enrolled in the study and randomly assigned to： Rifaximin （400 mg bid for 7 d every month） plus dietary fiber supplementation （at least 20 gr/d） or dietary fiber supplementation alone. The study duration was 24 mo; both clinical examination and symptoms＇ questionnaire were performed every two months. RESULTS： Both treatments reduced symptom frequency, but Rifaximin at a greater extent, when compared to basal values. Symptomatic score declined during both treatments, but a greater reduction was evident in the Rifaximin group （6.4±2.8 and 6.2 ± 2.6 at enrollment, P = NS, 1.0 ±0.7 and 2.4±1.7 after 24 mo, P 〈 0.001, respectively）. Probability of symptom reduction was higher and complication frequency lower （Kaplan-Meyer method） in the Rifaximin group （P 〈 0.0001 and 0.028, respectively）.CONCLUSION： In patients with symptomatic, uncomplicated diverticular disease, cyclic administration of RJfaximin plus dietary fiber supplementation is more effective in reducing both symptom and complication frequency than simple dietary fiber supplementation.Long term administration of the poorly absorbed antibiotic Rifaximin is safe and well tolerated by the patients,confirming the usefulness of this therapeutic strategy in the overall management of diverticular disease.

Body weight, lifestyle, dietary habits and gastroesophageal reflux disease

While lifestyle modifications are currently used as firstline treatment for subjects with gastroesophageal reflux disease (GERD), the pathogenetic role of lifestyle factors and consequently, the efficacy of lifestyle measures is controversial. Our aim was to systematically review the pathogenetic link between overweight/ obesity, dietary habits, physical activity and GERD, and the beneficial effect of specific recommended changes, by means of the available literature from the 1999 to the present. Obesity, in particular, abdominal obesity, plays a key role in determining GERD symptoms and complications through mechanical and metabolic effects. Controlled weight loss (by diet or surgery) is effective in improving GERD symptoms. No definitive data exist regarding the role of diet and, in particular, of specific foods or drinks, in influencing GERD clinical manifestations. Moderate physical activity seems to be beneficial for GERD, while vigorous activity may be dangerous in predisposed individuals. In conclusion, being obese/overweight and GERD-specific symptoms and endoscopic features are related, and weight loss significantly improves GERD clinical-endoscopic manifestations. The role of dietary behavior, mainly in terms of specific dietary components, remains controversial. Mild routine physical activity in association with diet modifications, i.e. a diet rich in fiber and low in fat, is advisable in preventing reflux symptoms.