SNFGE SNFGE
 
Thématique :
- Intestin
- Intestin/Nutrition/Troubles fonctionnels
Originalité :
Intermédiaire
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Docteur Pauline JOUET
Coup de coeur :
 
 
Gastroenterology
  2017/04  
 
  2017 Apr;152(5):980-982.e3  
  doi: 10.1053/j.gastro.2016.12.007  
 
  Rifaximin Reduces the Number and Severity of Intestinal Lesions Associated With Use of Nonsteroidal Anti-Inflammatory Drugs in Humans.  
 
  Scarpignato C, Dolak W, Lanas A, Matzneller P, Renzulli C, Grimaldi M, Zeitlinger M, Bjarnason I  
  https://www.ncbi.nlm.nih.gov/pubmed/28007576  
 
 

Abstract

The intestinal microbiota might contribute to enteropathy associated with use of nonsteroidal anti-inflammatory drugs (NSAIDs), but there have been few human studies of this association. We performed a placebo-controlled study to determine whether a delayed-release antibiotic formulation (rifaximin-extended intestinal release [EIR]) prevents the development of intestinal lesions in subjects taking daily NSAIDs. Sixty healthy volunteers (median age, 26 y; 42% female) were given the NSAID diclofenac (75 mg twice daily) plus omeprazole (20 mg once daily), and either rifaximin-EIR (400 mg) or placebo, twice daily for 14 days. Subjects were assessed by videocapsule endoscopy at baseline and after 2 weeks of treatment. The primary end point was the proportion of subjects developing at least 1 small-bowel mucosal break at week 2. Secondary end points were the change in the mean number of mucosal lesions and the number of subjects with large erosions and/or ulcers after 14 days of exposure. We detected mucosal breaks in 20% of subjects given rifaximin and in 43% of subjects given placebo (P = .05 in the post hoc sensitivity analysis). None of the subjects in the rifaximin group developed large lesions, compared with 9 subjects in the placebo group (P < .001). Our findings indicate that intestinal bacteria contribute to the development of NSAID-associated enteropathy in human beings. Clinical trial no: EudraCT 2013-000730-36.

 

 
Question posée
 
La prise de rifaximine diminue-t-elle la toxicité grêlique des AINS ?
 
Question posée
 
Dans cette étude effectuée chez 16 volontaires sains prenant du diclofenac et de l’omeprazole, la prise pendant 14 jours de rifaximine (une forme à libération grêlique retardée) était associée à deux fois moins de lésions intestinales à la vidéocapsule que le placebo (20% vs 43% ; p = 0.05 en analyse post-hoc), et aucun n’avait de larges érosions et/ou ulcères vs 9 sous placebo.
 
Commentaires

Une étude de concept en faveur du rôle des bactéries intestinales dans la toxicité des AINS au niveau du grêle, à confirmer dans chez des patients…

 
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