60 - Impact of Gut Decontamination by Rifaximin in Patients With Predicted Severe Acute Pancreatitis : A Pilot Study

Award: ACG Governors Award for Excellence in Clinical Research

Shivam Kalia, MBBS, MD¹, Preetam Nath, MBBS, MD, DM^2
1Kalinga Institute of Medical Sciences, Ghaziabad, Uttar Pradesh, India; ²Kalinga Institute of Medical Sciences, Bhubaneshwar, Orissa, India

Introduction: Majority(~80%) of cases with Acute Pancreatitis follow a mild, self-limited, and an uncomplicated course.About 20% cases develop necrosis of the pancreatic and/or peri-pancreatic tissue (necrotising pancreatitis).
Most common route for infection of pancreatic necrosis is translocation of intestinal flora due to intestinal barrier failure.
Infection of Pancreatic necrosis is associated with high mortality of 30-39%.
Use of rifaximin in the early phase of severe acute pancreatitis may be helpful to prevent infection of pancreatic necrosis by preventing the bacterial translocation and hence overall mortality

Methods: We conducted a randomized control trial on 100 patients(50 in each arm) that were admitted to our Department of Gastroenterology and Hepatology (kalinga institute of medical sciences) during 2021-2023 with a diagnosis of predicted severe acute pancreatitis based on modified Glasgow Imrie score. Thereafter, all the patients were divided into 2 groups: in the 1st group (Group A) , patients received rifaximin 550 mg twice daily for 14 days plus predetermined standardised treatment, and in the 2nd group (Group B) standard treatment only .
Primary objectives were development of infection of pancreatic necrosis and mortality.
Secondary objectives were duration of ICU or Hospital stay and development of organ failure

Results: A significant difference was observed between median durations of hospitalization between the groups, Group A (with rifaximin) and Group B (without Rifaximin) (8 days compared to 11.5 days, p value = 0.002) and ICU stay was less in Group A compared to group B ( 3 days compared to 5 days p value= 0.209) but the values were not statistically significant, Also in terms of development of organ failure between two groups the incidence was less in group A than group B ( 56% in group A and 60% in group B p value= 0.525) but values were not statistically significant. However there was no difference in the number of patients with infected pancreatic necrosum (31 compared to 35, p = 0.507). , there was no statistically significant difference between the group A and group B in terms of mortality rate ( 9 in group A compared to 14 in group B p value= 0.603).

Discussion: This study revealed that use of rifaximin in patients with predicted severe acute pancreatitis lead to overall reduction in length of hospital stay but did not have any impact on reducing the mortality.




Disclosures:


Shivam Kalia, MBBS, MD¹, Preetam Nath, MBBS, MD, DM², 60, Impact of Gut Decontamination by Rifaximin in Patients With Predicted Severe Acute Pancreatitis : A Pilot Study, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.