Effect of Administration of Rifaximin on the Portal Pressure of Patients With Liver Cirrhosis and Esophageal Varices
Effect of Administration of Rifaximin on the Portal Pressure of Patients With Liver Cirrhosis and Esophageal Varices
The purpose of this study is to assess whether the add of Rifaximin in patients with liver
 cirrhosis and esophageal varices treated with a standard therapy with beta blockers, leads to
 a significant reduction of portal hypertension.
It is well recognized that the gut flora may play an important role in the development of
 complications of liver cirrhosis, such as hepatic encephalopathy (HE), spontaneous bacterial
 peritonitis (SBP) and variceal bleeding, which are are directly caused or aggravated by the
 translocation of enteric bacteria or their products into the blood of cirrhotic
 patients.Preliminary studies have shown that selective intestinal decontamination appears to
 ameliorate the hyperdynamic circulatory state of cirrhosis. The investigators hypothesize
 that a modulation of gut microbiota by administering a non-adsorbable antibiotic, in addition
 to beta-blockers, can be a safe strategy to reduce the portal pressure, influencing favorably
 hemodynamics of portal circulation. Thus, the purpose of this study is to evaluate if in
 patients with liver cirrhosis and esophageal varices at high risk of bleeding, Rifaximin,
 administered in addition to standard therapy with beta - blockers (propranolol), for a time
 of 60 days: leads to a significant reduction of Hepatic Venous Pressure Gradient (it will be
 assessed by hepatic vein catheterization), 2) modify the intestinal flora in favor of
 specific families of bacteria (it will be assessed by fecal microbiota analysis), 3) change
 systemic inflammatory responses (it will be assessed by serum pro-inflammatory cytokines) 4)
 change in cognitive functions (it will be assessed by neuropsychological and
 electroencephalogram evaluations).
Inclusion Criteria:

 -  Diagnosis of liver cirrhosis (based on clinical, biochemical and radiological criteria
 with or without liver biopsy)

 -  Presence of esophageal varices at high risk of bleeding

 -  Hepatic Venous Pressure Gradient > 12 mmHg.

 -  19≤ age ≤75

 -  Informed Consent

 Exclusion Criteria:

 -  Patients already treated with beta blockers

 -  Treatment with systemic antibiotics and/or non-absorbable intestinal antibiotics in
 the previous two weeks

 -  Bacterial infection, spontaneous bacterial peritonitis

 -  overt hepatic encephalopathy in the last week

 -  active gastrointestinal bleeding, or in the last week

 -  active alcoholism or drug abuse in last 3 weeks

 -  Acute Alcoholic Hepatitis

 -  Hepatocellular carcinoma or other neoplasm

 -  significant coronary artery disease (angina NYHA III/IV), congestive heart failure
 (NYHA III/IV), relevant cardiomyopathy, history of myocardial infarct within the last
 12 months

 -  Contraindications to the administration of beta blockers; allergy to Rifaximin

 -  Pregnancy or breastfeeding

 -  Refusal to participate