EVALUATION OF THE EFFECTIVENESS OF COMBINATION THERAPY IN PATIENTS WITH DIFFERENT TYPES OF IRRITABLE BOWEL SYNDROME ASSOCIATED WITH SMALL INTESTINAL BACTERIAL OVERGROWTH

Abstract

Aim. To assess the effect of therapy with mebeverine, rifaximin and probiotics on clinical symptoms, small intestinal bacterial overgrowth (SIBO) eradication, fecal calprotectin (FC) level and the quality of life in irritable bowel syndrome patients with (IBS-D) or without diarrhea (IBS without D). Material and methods. Patients with IBS-D (n=74) or IBS without D (n=127) were randomly divided into 2 subgroups homogeneous for sex, age, FC level and IBS severity. Patients of subgroup I received mebeverine 0,4 g/day for 1 month in combination with sequential therapy, including rifaximin 0,8 g/day 6 days followed by S. boulardii 0,5 g/day 10 days, and followed by probiotic “Bifiform” 2 capsules/day for 15 days. Patients of subgroup II received mebeverine 0,4 g/day for 3 months in combination with 3 courses of sequential therapy, without interruption, including rifaximin and probiotics in the same doses. IBS severity (IBS-SS), quality of life (SF-36), FC level and frequency SIBO eradication were estimated prior to onset of treatment and after its termination. Results. Differences between the 2 subgroups of IBS-D patients in clinical improvement and SIBO eradication after 1 or 3 months of therapy weren’t significant (р>0,05). Reduction of clinical symptoms and SIBO eradication were significantly more frequent in IBS patients without D after 3 months than 1 month (p<0.012). A significant decrease in the patient’s proportion with elevated FC levels occurred after 3 months (p <0.0001). Conclusions. The three-month therapy is significantly better than the monthly therapy in IBS patients without D in reducing the IBS severity, increasing the SIBO eradication frequency and the patient’s proportion with normal FC. Differences in clinical efficacy after 1 or 3 months of therapy in IBS-D patients with normal FC levels aren’t detected (p>0.05). Normalization of FC level in IBS-D patients with elevated FC levels (>100 μg/g) is significantly more likely to be detected after 3 months of therapy than in one (p <0.0001).