Rifaximin for the Treatment of Persistent Symptoms in Patients With Celiac Disease
Rifaximin for the Treatment of Persistent Symptoms in Patients With Celiac Disease
Celiac disease is a condition in which the small intestine is damaged by gluten, the storage
 protein of wheat and similar proteins in barley and rye. The disease can cause different
 symptoms such as diarrhea, bloating, abdominal pain and weight loss. The majority of patients
 respond to a gluten-free diet. However some patients (5-30%) have persistent symptoms and are
 considered to be poor responders to the diet. Bacterial overgrowth in the small intestine
 accounts for some of the refractory patients.

 This study seeks to determine if antibiotic therapy with rifaximin relieves the symptoms of
 patients who are poorly responsive to a gluten-free diet and whether this impacts their
 breath test results.
A symptom questionnaire will be administered at study initiation, 2 weeks and 12 weeks.
 Patients will undergo a breath test which involves drinking a sugar (lactulose) solution and
 breathing into a machine. This technique will identify the presence of bacteria in the small
 intestine. They will be randomly selected to receive either an antibiotic (rifaximin) or
 placebo three times a day for 10 days to treat their bacterial overgrowth.
Inclusion Criteria:

 -  Adult patients age 18 or older

 -  Biopsy proven celiac disease

 -  Persistent symptoms of diarrhea, gas, bloating and/or cramping despite a gluten free
 diet for at least 1 month

 -  Women that are not pregnant or lactating can be included. All women must have a
 documented negative pregnancy test at the initiation of the study. Women who become
 pregnant during the study will be asked to discontinue the study drug and will be
 followed up until the outcome of pregnancy is known. Women of child bearing potential
 must be practicing an effective method of birth control (eg: prescription oral
 contraceptive, contraceptive injections, intra-uterine device, double barrier method,
 contraceptive patch, male sterilization) before entry and throughout the treatment
 period.

 Exclusion Criteria:

 1. antibiotic use for any indication within preceding one month

 2. use of bismuth compounds within preceding month

 3. concomitant use of pancreatic supplements

 4. concomitant use of antispasmodics

 5. concomitant use of immunomodulators such as corticosteroids, budesonide, alkylating
 agents and antimetabolites.

 6. concomitant use of probiotics

 7. concomitant use of prokinetic agents

 8. concomitant use of 5HT3 antagonists, 5HT4 agonists

 9. concomitant use of antimotility agents (e.g loperamide)

 10. concomitant use of antidiarrheal agents

 11. diagnosed microscopic colitis or inflammatory bowel disease

 12. other causes of malabsorption: pancreatic insufficiency, giardiasis and enteropathy
 associated with T cell lymphoma.

 13. other diseases: renal or hepatic insufficiency.

 14. pregnant patients and lactating females. In addition women of child bearing age will
 be excluded if they are not using one of the methods of contraception like oral
 contraceptives, IUD and double barrier methods.

 15. patients with tuberculosis or a positive PPD test and infection with other
 mycobaterial diseases.

 16. allergy and/or potential emergence of drug resistance to rifampicin and rafamycin
 compounds.