Rifaximin Modify the Pathogenesis of Non-Alcoholic Fatty Liver Disease (NAFLD)

The investigators aimed to study the effect of rifaximin on NASH. 50 patients with biopsy-proven NASH were enrolled in this double-blind, randomized,placebo-controlled study. BMI, AST, ALT, gamma glutamyl transferase (γ-GGT), lipid profile, homeostatic model assessment (HOMA), serum endotoxin, Toll-like receptor 4 (TlR4), interleukin-6 (IL-6), IL-10, tumor necrosis factor-α (TNF-α) and cytokeratin-18 (CK-18) levels were measured before and after a 6 month administration of rifaximin (1100mg/day, 550 mg tablets 1 × 2 before meals).

Inclusion criteria

• women or men aged 18-65 years.
• biopsy-proven NASH without or with mild to moderate fibrosis (fibrosis stage 0-3)in the preceding year.
• persistently abnormal ALT on 2 occasions.
• participants have provided written informed consent before screening.
• all patients counseled about the standard of care treatment (e.g., diet andexercise).
• Strict requirements for weight stability between the time of biopsy and study entry.

Exclusion criteria

• Cirrhotic NAFLD (METAVIR stage 4).
• Combined viral hepatitis B and C infection.
• increased alcohol intake (>20 g/day) and hypothyroidism.
• co-existence of another type of biliary tract or pancreatic or liver diseases
• lactating or pregnant women.
• allergy to rifamycin or rifaximin.
• systemic inflammatory conditions (e.g. Connective tissue diseases and inflammatory bowel diseases).
• bariatric surgery and blind loop.
• evidence of hepatic decompensation (ascites, hepatic encephalopathy, and varices),
• history of myocardial infarction and/ or stroke within 6 months.
• drugs that alter the gut flora e.g. Lactulose, systemic antibiotic, cholestyramine within three months, (l) cancers especially HCC, and (m)patients with renal impairment (estimated GFR <60ml/min/1.73m2).

(n) Major dose change orintiation of biguanides, metformin, thiazolidinediones, insulin, fibrates, statins, and anti-obesity medications within three months before the onset of the study.