Abstract
Background
The effects of poorly/non-absorbable antibiotics on hepatic venous pressure gradient
(HVPG) are debated.
Aim
To analyze the effects of rifaximin or norfloxacin on HVPG and on markers of bacterial
translocation and proinflammatory cytokines.
Methods
We performed a systematic search of randomized clinical trials (RCTs) involving patients
with cirrhosis and portal hypertension, assessing the effect of rifaximin or norfloxacin
vs control on HVPG. Pooled analyses were based on random-effects models, heterogeneity
was assessed by Cochran's Q, I2 statistic and subgroup analyses.
Results
Five studies (215 patients) were included. Risk of bias was high in three. We found
no significant differences using antibiotics versus control. The summary mean difference
in HVPG was of -0.55 mmHg (95%CI:-1.52, 0.42; P = 0.27), with moderate heterogeneity (P = 0.15; I2 = 40%). RCTs with longer therapy (60–90 days) used non-selective-beta-blockers (NSBB)
in both antibiotics and control arms. Subgroup analysis showed a significantly greater
reduction in HVPG in the combination arm over controls (mean difference -1.46 mmHg
[95%CI: −2.63, −0.28; P = 0.01]) with no heterogeneity (P = 0.46; I2 = 0%). Serum lipopolysaccharide-binding protein (LBP) significantly decreased with
antibiotics, but with high heterogeneity (P < 0.001; I2 = 92%).
Conclusions
Rifaximin or norfloxacin did not significantly reduce HVPG in patients with cirrhosis
and portal hypertension. Studies using antibiotic for longer periods on top of NSBB
showed a significant decrease in HVPG.
Keywords
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Article info
Publication history
Published online: July 28, 2020
Accepted:
June 29,
2020
Received:
May 16,
2020
Identification
Copyright
© 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
