Xifaxan (rifaximin) / Alfa Wassermann, Bausch Health, Lupin, Norgine, ASKA Pharma - LARVOL DELTA

Rifaximin‑α (α‑Polymorph): Multimodal, Gut‑Targeted MoA (UEGW 2026) - "Sponsored by ALFASIGMA"

LONG-TERM RIFAXIMIN USE IS ASSOCIATED WITH INCREASED ANTIMICROBIAL RESISTANCE AND ESBL-PRODUCING ORGANISMS IN DECOMPENSATED CIRRHOSIS PATIENTS WITH FIRST-EPISODE SPONTANEOUS BACTERIAL PERITONITIS (UEGW 2026) - "ESBL-producing organisms were more frequent (34.2% vs 18.4%, p=0.047), as was resistance to ceftriaxone (34.2% vs 18.4%, p=0.047). Increased resistance was also observed for ciprofloxacin (46.9% vs 21.1%, p=0.007), ampicillin (68.0% vs 39.7%, p=0.016), and amoxicillin-clavulanate (31.6% vs 8.6%, p=0.040).Subgroup analysis by cirrhosis etiology showed that this association was most pronounced in patients with cryptogenic cirrhosis (p=0.048). Long-term rifaximin use is associated with increased antimicrobial resistance and ESBL-producing organisms in patients with decompensated cirrhosis and first-episode SBP, without changes in pathogen distribution. These findings support a more selective use of rifaximin and highlight the importance of balancing its clinical benefits against the potential risk of promoting antimicrobial resistance."

Clinical • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Liver Cirrhosis

DYNAMIC AMMONIA FLUCTUATION WITH SLEEP ARCHITECTURE INSTABILITY AND IMPAIRED GLYMPHATIC CLEARANCE ASSOCIATES WITH A HIDDEN TRANSITION STATE TOWARD OVERT HEPATIC ENCEPHALOPATHY IN CIRRHOSIS DURING NOCTURNAL NEUROPHYSIOLOGICAL STRESS (UEGW 2026) - "An ammonia sleep instability pattern may help clinicians recognise preclinical encephalopathy before confusion, admission, or unsafe discharge. This strategy supports earlier lactulose or rifaximin optimisation, sleep-targeted counselling, caregiver warning plans, and closer follow-up in cirrhosis patients with nocturnal neurophysiological stress."

CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Sleep Disorder

PROPHYLACTIC ANTIBIOTIC REGIMENS VERSUS PLACEBO OR NO PROPHYLAXIS IN HOSPITALISED PATIENTS WITH DECOMPENSATED CIRRHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS (UEGW 2026) - "Prophylactic antibiotics, predominantly norfloxacin-class fluoroquinolones and systemic cephalosporins, significantly reduce short-term mortality and bacterial infection rates in hospitalised patients with decompensated cirrhosis without overt infection. Rifaximin did not demonstrate a mortality benefit in the available high-quality trial. These findings support the routine use of prophylactic fluoroquinolones or cephalosporins in this setting while underscoring the need for further trials to clarify the role of rifaximin and TMP-SMX, and to monitor the emergence of antimicrobial resistance."

Retrospective data • Review • Acute Kidney Injury • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Nephrology • Renal Disease

THE STUDY OF INFLUENCE OF MICROBIOME TO PROGRESSION OF FIBROSIS IN PATIENTS WITH LIVER CIRRHOSIS (UEGW 2026) - "An increase in the level of indicators of endogenous intoxication leads to an increase of the production of pro-fibrogenic factor TGF-beta1, which stimulate fibrogenesis and decrease the detoxification function of the liver, which causes the progression of the LC.The usage of the Rifaximin significantly reduces the level of profibrogenic cytokine TGF-beta1 and TIMP-1 through an indirect effect on the main pathogenetic mechanisms of disease development."

Clinical • Fibrosis • Gastroenterology • Hepatology • Immunology • Liver Cirrhosis • TGFB1 • TIMP1

GUT–LIVER AXIS DYSFUNCTION IN MASLD: THE ROLE OF MICROBIOME AND INTESTINAL BARRIER INTEGRITY (UEGW 2026) - "Patients received combined therapy including lifestyle modification, rifaximin, followed by probiotics (Saccharomyces boulardii, Lactobacillus acidophilus LA-5, and Bifidobacterium animalis subsp... MASLD is associated with gut microbiota dysbiosis and increased intestinal permeability. Microbiome-targeted therapy may improve metabolic parameters, restore microbial balance, and enhance intestinal barrier integrity, highlighting the gut–liver axis as a promising therapeutic target."

Inflammation • Liver Failure • Metabolic Dysfunction-Associated Steatotic Liver Disease • CRP

FROM DYSBIOSIS TO BARRIER RESTORATION: TARGETING THE GUT–LIVER AXIS IN MASLD (UEGW 2026) - "Patients underwent a stepwise microbiome-targeted intervention consisting of rifaximin followed by probiotic therapy, combined with lifestyle modification... These findings highlight intestinal permeability and microbiome alterations as key contributors to MASLD pathogenesis. Targeting the gut–liver axis through microbiome modulation may represent an effective strategy to restore barrier integrity and improve metabolic outcomes."

Dysbiosis • Hepatology • Inflammation • Metabolic Dysfunction-Associated Steatotic Liver Disease

HEPATIC ENCEPHALOPATHY IN ALCOHOL-RELATED CIRRHOSIS: A SYSTEMATIC REVIEW OF FREQUENCY, TREATMENT AND PROGNOSIS (UEGW 2026) - "HE in alcohol-related cirrhosis represents a high-risk clinical scenario with substantial short-term mortality. Rifaximin and lactulose remain the mainstay for recurrence prevention, while PEG may offer advantages in acute settings. Active alcohol use significantly worsens prognosis and should be addressed as part of integrated management."

Review • Addiction (Opioid and Alcohol) • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology

THE GUT-LIVER-METABOLIC AXIS: FROM GENETIC SUSCEPTIBILITY AND BARRIER FAILURE TO MICROBIOME-TARGETED RECOVERY IN MASLD AND DYSLIPIDEMIA (UEGW 2026) - "Diagnostic protocols included:Gut Health: Lactulose hydrogen breath test (SIBO), fecal zonulin ELISA (permeability), and qRT-PCR (microbiome profiling Systemic Markers: TNF-α, hsCRP, and full lipid panels Hepatic Assessment: Ultrasound and steatometry (dB/cm/MHz) to quantify fat content and liver stiffness. Intervention: A 12-week multimodal protocol featuring lifestyle modifications, Rifaximin, and a specific probiotic blend (Lactobacillus acidophilus LA-5 and Bifidobacterium lactis BB-12) SIBO was prevalent in >50% of patients, correlating with a high Firmicutes/Bacteroidetes (F/B) index... These findings confirm that the gut microbiome is a central regulator of metabolic health. By restoring the intestinal barrier and microbial balance, targeted interventions effectively mitigate systemic inflammation (TNF-α), improve hepatic structure, and normalize lipid metabolism. This research supports the integration of microbiome-targeted therapies as a cornerstone of..."

Dyslipidemia • Hepatology • Inflammation • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • CRP • TNFA

EFFECT OF MIDODRINE ON SHORT TERM MORTALITY AND LIVER FUNCTION IN PATIENTS WITH CIRRHOSIS AND ASCITES: A SYSTEMATIC REVIEW AND META-ANALYSIS (UEGW 2026) - "Aims & A systematic search was conducted for randomized controlled trials comparing midodrine (with or without rifaximin) to standard medical therapy or albumin in cirrhotic patients with ascites. Midodrine is associated with significant improvements in both short-term mortality and liver function, as assessed by MELD score, in patients with cirrhosis and ascites. These findings support the consideration of midodrine as a therapeutic adjunct in selected patients. Further large-scale, multicenter trials are warranted to validate these results."

Retrospective data • Review • Fibrosis • Hepatology • Immunology • Liver Cirrhosis

COMPARISON OF THERAPEUTIC EFFICACY BETWEEN RIFAXIMIN AND L-CARNITINE FOR HYPERAMMONEMIA IN LIVER CIRRHOSIS: A MULTICENTER RETROSPECTIVE STUDY FOCUSING ON LONG-TERM EVENT PREVENTION (UEGW 2026) - "Both RIF and CAR are effective and safe therapeutic options for managing hyperammonemia in patients with liver cirrhosis in real-world settings. While their efficacy in achieving ammonia normalization is comparable, RIF demonstrated superior effectiveness in preventing hyperammonemia-related clinical events and significantly reducing HE-related hospitalizations. These findings suggest that RIF may provide additional benefits beyond ammonia reduction, possibly through modulation of gut-derived neurotoxins and inflammation."

Retrospective data • CNS Disorders • Fibrosis • Gastroenterology • Hepatic Encephalopathy • Hepatology • Immunology • Inflammation • Liver Cirrhosis

A COMPARISON OF DUODENAL ASPIRATE CULTURE, GLUCOSE BREATH TEST AND GAS-SENSING CAPSULE DATA ON THE SYMPTOMATIC RESPONSE TO RIFAXIMIN IN PATIENTS WITH DGBI (UEGW 2026) - "Likewise, claims that rifaximin reduces bacterial density in the colon are only supported by the retrospective association of non-hydrogen (H2) production after lactulose with antibiotic responsiveness. Luminal gases appear to predict patients' response to rifaximin with higher accuracy than measures of SIBO, showing promise as an alternative diagnostic method to guide antimicrobial therapy in patients with unexplained upper GI symptoms. The data suggests that rifaximin may be acting via a non-specific reduction of intestinal bacterial density rather than a specific treatment for SIBO."

Dyspepsia • Gastrointestinal Disorder

CONCURRENT PARAUMBILICAL VEIN EMBOLIZATION AND TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT CREATION FOR MANAGEMENT OF REFRACTORY HEPATIC ENCEPHALOPATHY (UEGW 2026) - "Despite combination of lactulose and rifaximin therapy, her symptoms did not improve significantly and was prone to recurrence. She developed no recurrence of HE or gastrointestinal rebleeding within 18 months, with significant alleviation of ascites as well. This case highlights concurrent PUV embolization and TIPS creation may be an effective approach for management of medically refractory HE while lowering the risk of portal hypertension complications."

Cardiovascular • CNS Disorders • Fibrosis • Hepatic Encephalopathy • Hepatology • Immunology • Portal Hypertension • Primary Biliary Cholangitis

ABERNETHY SYNDROME – AN IRREVERSIBLE CAUSE OF HEPATIC ENCEPHALOPATHY? (UEGW 2026) - "Serum ammonia levels were elevated (114 mmol/L).In this context, the patient's cognitive and motor impairments were attributed to hepatic encephalopathy; however, no clinical improvement was observed with lactulose and zinc therapy between ages 13 and 14, leading to discontinuation of treatment. At 20 years, he initiated follow-up with an adult hepatology team, with plans for brain MRI and a renewed therapeutic trial with L-ornithine L-aspartate and rifaximin.Abernethy syndrome represents a cause of non-cirrhotic hepatic encephalopathy. Early recognition and appropriate management may help mitigate neurological injury; however, it remains uncertain whether they effectively prevent permanent neurological deficits, and whether, in advanced stages, specific therapies such as liver transplantation can still provide meaningful clinical benefit."

CNS Disorders • Hepatic Encephalopathy • Hepatology • Movement Disorders

ACUTE ESOPHAGEAL NECROSIS (GURVITS' ESOPHAGUS) MIMICKING VARICEAL HEMORRHAGE IN A PATIENT WITH DECOMPENSATED LIVER DISEASE (UEGW 2026) - "Initial impression was variceal versus peptic ulcer bleeding; blood transfusion, esomeprazole, and octreotide infusion were initiated...Worsening sensorium prompted treatment for hepatic encephalopathy (lactulose, rifaximin, L-ornithine L-aspartate). Ceftriaxone was given for spontaneous bacterial peritonitis prophylaxis. Fluids and electrolytes were corrected. However, given clinical decline, the family opted for palliative care with transition to home-based management."

Clinical • Acute Kidney Injury • Cardiovascular • Chronic Cough • Chronic Kidney Disease • CNS Disorders • Cough • Diabetes • Diabetic Nephropathy • Fibrosis • Gastrointestinal Disorder • Heart Failure • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Liver Cirrhosis • Metabolic Disorders • Metabolic Dysfunction-Associated Steatotic Liver Disease • Nephrology • Peptic Ulcer • Renal Disease • Respiratory Diseases • Type 2 Diabetes Mellitus

GIANT INFLAMMATORY PSEUDOPOLYPS IN A PATIENT WITH ULCERATIVE COLITIS CAUSING SUBOCCLUSION (UEGW 2026) - "When their size exceeds the arbitrary point of 1.5 cm, they are classified as giant pseudopolyps and they can cause obstructive symptoms.We present the case of patient, female, 66 years with ulcerative colitis (UC) in the last 20 years, mild form, being only on 5-ASA, short term corticosteroids and alfa rifaximin in flares- she had only 3 flares.The patient had the last colonoscopy in 2015, that revealed left-side ulcerative colitis with small pseudopolyps in the sigmoid colon and she received 5-ASA 3g/day. Giant inflammatory pseudopolyps (>1,5cm) are a rare complication of inflammatory bowel disease (IBD) and may have malignant islands, so careful monitoring of these lesions is important with multiple biopsies. Polypectomy is indicated if there is suspicion of dysplasia or if they cause subocclusion."

Clinical • Constipation • Gastroenterology • Gastrointestinal Disorder • Immunology • Inflammatory Bowel Disease • Ulcerative Colitis

PANNICULITIS, ANEMIA, WEIGHT LOSS AND ARTHRALGIA: A LONG JOURNEY TO WHIPPLE DISEASE (UEGW 2026) - "pylori eradication, iron replacement, rifaximin, and therapy of possible functional symptoms had a partial effect. During the next couple of years, she periodically had diarrhea that was relieved with short courses of trimethoprim/sulfamethoxazole...Initial treatment with ceftriaxone IV for 14 days with subsequent starting of doxycycline and hydroxychloroquine has been effective for symptom relief. This clinical case emphasizes the complexity of the WD diagnosis, the clinical presentation of which may mimic other diagnoses, including functional GI disorders, and where appropriate, initial diagnostic workup may not give a right diagnosis. Therefore, repeating of a comprehensive diagnostic work-up should be considered in any doubtful cases even though rare diseases are «rare»."

Anemia • Gastrointestinal Disorder • Hematological Disorders • Infectious Disease • Musculoskeletal Pain • Rare Diseases

THE SILENT RISE OF AMMONIA: NON-HEPATIC HYPERAMMONAEMIC ENCEPHALOPATHY FOLLOWING GASTRIC BYPASS SURGERY (UEGW 2026) - "Lactulose and rifaximin were also initiated. Our case report underscores the importance of early serum ammonia measurement in post‑bariatric surgery patients presenting with unexplained altered mental status, to enable prompt recognition and timely management of non-hepatic hyperammonaemic encephalopathy. Unmasking of an underlying urea cycle defect should also be considered as a differential diagnosis in such cases."

Bariatric surgery • Surgery • Cardiovascular • CNS Disorders • Gastrointestinal Disorder • Genetic Disorders • Hepatology • Metabolic Disorders • Pulmonary Embolism • Respiratory Diseases

ALTERATION OF SMALL AND LARGE BOWEL MICROBIAL SIGNATURES FOLLOWING FECAL MICROBIOTA TRANSPLANTATION (FMT) FOR IRRITABLE BOWEL SYNDROME WITH GUT -BRAIN AXIS FEATURES: OBSERVATIONS USING A SMALL INTESTINAL CAPSULE PROTOCOL (UEGW 2026) - P | "Antimicrobials included vancomycin 250 mg tid in liquid form, nitazoxanide 500 mg bid, norfloxacin 400 mg bid, rifaximin 550 mg bid and nystatin 2M units bid. In this exploratory usage of SIMBA capsules to assess the biology of IBS, differentiation of small bowel vs colonic changes may help assess the role of specific microbial compositions at different sites and enable correlations between microbes and clinical findings to better understand the pathogenesis of IBS."

Clinical • Gastrointestinal Disorder • Infectious Disease • Inflammatory Bowel Disease • Transplantation • KIT

PAROMOMYCIN IS AN EFFECTIVE TREATMENT OPTION FOR RIFAXIMIN-REFRACTORY SMALL INTESTINAL BACTERIAL OVERGROWTH: A RETROSPECTIVE ANALYSIS (UEGW 2026) - "Due to its broad spectrum of antimicrobial activity and pharmacokinetic profile3, current literature emphasizes rifaximin as first-line treatment in patients tested positive for lactulose or glucose breath test1,4. Despite preliminary, our findings hint at paromomycin as a promising therapeutic option in patients with rifaximin-refractory SIBO, with remarkable safety profile and noteworthy impact on bloating and abdominal pain."

Retrospective data • Constipation • Gastroenterology • Gastrointestinal Disorder

COMBINED EFFECTS OF RIFAXIMIN-Α AND LACTICASEIBACILLUS PARACASEI DG ON GUT MICROBIOTA METABOLISM AND INFLAMMATION IN VITRO (UEGW 2026) - "The susceptibility of LpDG to low concentrations of RFX supports its safety profile for human consumption, according to European Food Safety Authority (EFSA) requirements regarding the absence of acquired antimicrobial resistance. Nevertheless, LpDG and RFX co-treatment enhanced drug anti-inflammatory efficacy on gut epithelium regardless of LpDG susceptibility, reinforcing the rationale for a co-administration strategy.In CoaP simulation, both LpDG formulations had an impact on microbiota metabolism by improving the short-chained-fatty-acid profile while avoiding the production of detrimental molecules. Furthermore, probiotic supplementation induced subtle but consistent shifts in microbial community composition, detectable by beta-diversity analyses, without affecting alpha-diversity, indicating a donor-dependent functional reorientation of the relative abundances of bacterial taxa rather than a broad restructuring of microbiota richness or evenness."

Gut Microbiota • Preclinical • Gastrointestinal Disorder • Inflammation • Mucositis • IL1B

Antibiotic therapy for small intestinal bacterial overgrowth: a systematic review of comparative efficacy, clinical-test discordance, and pediatric evidence gaps. (PubMed, Front Pharmacol) - "Rifaximin was the most frequently studied antibiotic, although outcomes varied considerably...Evidence is insufficient to identify a preferred pediatric regimen. Treatment success should integrate symptoms, objective response, tolerability, recurrence, and patient phenotype."

Journal • Review • Pain • Pediatrics

Olmesartan-Associated Sprue-Like Enteropathy With Concurrent Intestinal Methanogen Overgrowth and Secondary Disaccharidase Deficiencies: Delayed Diagnosis With Histologic and Enzymatic Recovery After Drug Discontinuation (ACG 2026) - "Olmesartan was switched to telmisartan, and IMO treated with neomycin 500 mg twice daily and rifaximin 550 mg three times daily for 14 days. Mayo Clin Proc. 2012;87:732-738."

Anorexia • Cardiovascular • Celiac Disease • Gastrointestinal Disorder • Human Immunodeficiency Virus • Hypertension • Immunology • Infectious Disease • Inflammation

Non-Cirrhotic Confusion: Portosystemic Encephalopathy in Hereditary Hemorrhagic Telangiectasia (ACG 2026) - "Her mental status improved significantly with lactulose and rifaximin therapy. Liver transplantation remains the only definitive cure for hepatic HHT and should be considered in patients with refractory complications. This case demonstrates a rare presentation of hepatic HHT and emphasizes the need to consider portosystemic encephalopathy in patients with altered mental status despite preserved liver function."

Cardiovascular • CNS Disorders • Congestive Heart Failure • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Hematological Disorders • Hepatic Encephalopathy • Hepatology

A Hidden Culprit: Refractory Hepatic Encephalopathy Secondary to a Large Spontaneous Splenorenal Shunt (ACG 2026) - "He required oral and rectal lactulose along with rifaximin to remain alert; omission of a single dose prompted reintubation. (B) Intra-obliteration image with BRTO device in the shunt. (C) Post-obliteration image showing absence of contrast within the shunt."

Cardiovascular • CNS Disorders • Fibrosis • Hematological Disorders • Hepatic Encephalopathy • Hepatology • Immunology • Portal Hypertension