S369 Efficacy and Safety of Rifaximin for IBS in Diarrheal and Non-Diarrheal Patients: A Systematic Review and Meta-Analysis

Introduction: Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder marked by abdominal discomfort, bloating, and altered bowel habits, often leading to a significant reduction in quality of life. Rifaximin, a minimally-absorbed, gut-targeted antibiotic has emerged as a promising treatment for symptom relief. Beyond its microbiota-modulating effects, studies have shown consistent improvement in bloating and overall well-being, even in patients with constipation-predominant IBS. This meta-analysis evaluates the efficacy of rifaximin in improving bloating, alleviating constipation, and enhancing quality of life in individuals with IBS. Methods: The review conducted follows the PRISMA guidelines. PUBMED, Google Scholar and Science-Direct were searched using a comprehensive search term to identify and retrieve available articles. The articles included Rates of Relief of Symptoms and Difference in constipation severity. The data was analyzed using the Meta, Metadata and the Metafor packages of R Studio. The proportion of the Odds Ratio (OR) of Relief of Global Symptoms between rifaximin vs placebo was assessed as our primary outcome. The proportion of the odds ratio (OR) of relief of bloating symptoms and difference in constipation severity post treatment with rifaximin vs placebo were assessed as secondary outcomes. The Mantel-Haenszel method and the Inverse variance method were utilized to analyze the odds ratio. The I2 test was used to assess the heterogeneity of the studies. Results: The study included a total of 12 studies where 3,022 patients with IBS received rifaximin therapy and 3,115 patients were in the control group. Patients who received rifaximin showed significantly higher rates of Relief of Global Symptoms (OR = 1.51 [1.32; 1.72], 95% confidence interval (CI), P= 0.02194, I2 = 28.7%). Patients receiving rifaximin also reported increased relief from bloating symptoms (OR = 1.47 [1.28; 1.68], 95% CI, P= 0.6197, I2 = 0.0%). There was a notable reduction in the severity of constipation in the Rifaximin group (OR = 1.47 [1.28; 1.68], 95% CI, P= 0.6197, I2 = 0.0%). Conclusion: Our study indicates that patients on rifaximin therapy showed higher rates of Relief of Global Symptoms in comparison to placebo group. Patients receiving rifaximin also showed increased relief from bloating symptoms and a notable reduction in the severity of constipation. This highlights the potency of rifaximin in improvement of symptoms of IBS.