Rifaximin for Irritable Bowel Syndrome (IBS) in Gulf War Veterans: Losing the Battle but Winning the War?

Excerpt

Conquering the treatment of irritable bowel syndrome (IBS) is somewhat like trying to win a war. Many enemies have been implicated in its causation, among them visceral hypersensitivity, alterations in intestinal permeability and motility, brain–gut dysregulation, defects in the autonomic nervous system, alterations in GI immune function, hormones, psychosocial factors, and most recently alterations in the gut microbiome. Many have realized that the symptoms of small intestinal bacterial overgrowth (SIBO) such as changes in bowel habit, cramping, and bloating to mention just a few are remarkably similar to IBS. Therefore, testing for SIBO and treating it with antibiotics, particularly the poorly absorbable broad-spectrum antibiotic rifaximin, have conceptually evolved in the area of IBS therapies [1]. Further support for the post-infectious nature of IBS is also found in the identification of biomarkers that are antibodies to bacterial toxins in patients who have IBS with diarrhea (IBS-D) or mixed bowel habits (IBS-M) [2] combined with the observation that chronic diseases such as IBS can often follow infectious gastroenteritis [3]. With over 50% of military personnel having gastroenteritis while being deployed in the Gulf, this would seem to be an ideal population in which to study post-infectious IBS. In this issue of Digestive Diseases and Sciences, Tuteja et al. reported that up to a third of Gulf War (GW) Veterans have IBS, and despite the pressures of war and posttraumatic stress disorder, the biggest risk factor for getting IBS may indeed be prior infection [4]. Given the high number of subjects identified, the authors tested the hypothesis that rifaximin would “normalize SIBO” and thus reduce IBS symptoms. …