TO COMPARE THE EFFICACY OF (RIFAXIMIN + MEBEVERINE), (RIFAXIMIN + AMITRIPTYLINE) AND (RIFAXIMIN + PSYLLIUM HUSK) IN IRRITABLE BOWEL SYNDROME ASSOCIATED WITH DIARRHEA

Abstract

Irritable bowel syndrome is a heterogenous disorder that affects gastrointestinal tract. It is characterized by altered bowel habits and discomfort. The syndrome clinically presents discomfort associated with abdominal pain; irregular stool patterns accompanied with bloating. The prevalence of IBS in Pakistan is around 21% (Quddus et al., 2021). It is difficult to diagnosis because no suitable biomarker is available. IBS is mainly treated symptomatically. The study compares the efficacy of drug combinations i.e. (Rifaximin + Mebeverine), (Rifaximin + Amitriptyline) and (Rifaximin + Psyllium Husk) in individuals suffering from IBS associated with diarrhea. It was conducted in National Medical Center Karachi, during a period of six months on 162 diagnosed patients of irritable bowel syndrome associated with diarrhea. Individuals of both genders, between the age of 18-45 years were evaluated based on ROME IV criteria and included in the study. Patients were divided into 3 groups each having 54 members. Each group was given a treatment regime i.e., Group A: Tablet Rifaximin 550 mg and Tablet Mebeverine 135 mg, Group B: Tablet Rifaximin 550 mg and Tablet Amitriptyline 25mg Group C: Tablet Rifaximin 550 mg and Psyllium Husk 15-30gm for 14 days. A Blood test was done to check for problems like coeliac disease, thyroid profile to access thyroid related issues, Fecal Calprotectin was done to differentiate between IBD and IBS and to rule out other gastrointestinal infections. After written informed consent each patient experienced a wash-out period of 72 hours. Parameters checked at 0 and 2 weeks were: abdominal pain that coincides with alteration of bowel habits and diarrhea. Adverse effects of drugs were also observed. The ANOVA test was used for statistical analysis. Significant results ( p < 0.002) in parameter of severity of abdominal pain and ( p < 0.006) in parameter of frequency of diarrhea on day 14 was shown among the groups. Significant differences were also found in heartburn, bloating and dry mouth among the three groups while most of the adverse effects showed non-significant results. The study concluded that combination therapy of rifaximin and amitriptyline was clinically superior to other regimes in management of IBS-D. Combination therapy had a better outcome with safety profile as well as improved in the quality of life