慢性假性肠梗阻（CIPO）是一种罕见的难治性疾病，治疗选择有限。小肠细菌过度生长（SIBO）通常与几种疾病同时发生，包括CIPO。虽然利福昔明（RFX）可有效治疗SIBO，其对CIPO的疗效尚不清楚。这里,我们旨在研究RFX在CIPO成年患者中的疗效和安全性。12名患者被随机分配接受RFX(400毫克，每天三次，n=8)或安慰剂(PBO，n=4)持续4周。收集腹胀的整体症状评分（GSS-腹胀）和原始的整个胃肠道症状评分（O-WGSS），进行葡萄糖氢呼气试验（GHBT）和腹部计算机断层扫描（CT）。在主要终点没有观察到显著差异。PBO和RFX组的GSS膨胀率分别提高了75%和25%，分别,和O-WGSS在两组中提高了25%。在次要终点和其他终点没有观察到显著差异，包括GHBT中的SIBO根除率和CT上的小肠体积。在对SIBO阳性CIPO患者的事后分析中（PBO和RFX组中的4/4和4/8），SIBO在25%和75%的患者中根除（PBO和RFX组，分别)在治疗结束时，表明RFX组的根除率高。此外，RFX组小肠气体量减少，无严重不良事件发生。虽然主观指标没有显著改善，RFX可能有利于减轻SIBO和减少SIBO阳性CIPO患者的小肠气体体积。
Chronic intestinal pseudo-obstruction (CIPO) is a rare intractable disease with limited treatment options. Small intestinal bacterial overgrowth (SIBO) often co-occurs with several diseases, including CIPO. While rifaximin (RFX) is effective in treating SIBO, its efficacy for CIPO remains unclear. Here, we aimed to investigate the efficacy and safety of RFX in adult patients with CIPO. Twelve patients were randomly assigned to receive RFX (400 mg three times daily, n=8) or a placebo (PBO, n=4) for 4 weeks. The global symptom score for abdominal bloating (GSS-bloating) and an original whole gastrointestinal symptoms score (O-WGSS) were collected, and a glucose hydrogen breath test (GHBT) and abdominal computed tomography (CT) were performed. No significant differences were observed in the primary endpoint. GSS-bloating improved by 75% and 25% in the PBO and RFX groups, respectively, and O-WGSS improved by 25% in both groups. No significant differences were observed in secondary and other endpoints, including the SIBO eradication rate in the GHBT and small intestinal volume on CT. In a post hoc analysis of SIBO-positive patients with CIPO (4/4 and 4/8 in the PBO and RFX groups), SIBO was eradicated in 25% and 75% of the patients (PBO and RFX groups, respectively) at the end of treatment, indicating a high eradication rate in the RFX group. Furthermore, the small intestinal gas volume decreased in the RFX group, and no severe adverse events occurred. Although no significant improvements were observed in subjective indicators, RFX may be beneficial in alleviating SIBO and reducing the small intestinal gas volume in SIBO-positive patients with CIPO.
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