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Endotoxaemia resulting from intestinal bacterial overgrowth could reduce platelet counts directly or through cytokine release.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To correlate endotoxaemia with platelet counts and study the effects of intestinal decontamination with rifaximin on thrombocytopenia in relation to changes in endotoxin and cytokine concentrations in patients with alcoholic cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Platelet counts, plasma endotoxin levels and serum interleukin\u20101 (<jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20101), interleukin\u20106 (<jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106) and tumour necrosis factor\u2010\u03b1 (<jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010\u03b1) levels were measured in 23 thrombocytopenic cirrhotic patients (platelet count&lt;150\u00a0000\/\u03bcl) before and after 4\u2010week treatment with rifaximin 1200\u00a0mg\/d (<jats:italic>n<\/jats:italic>\u00a0=\u00a013) or no treatment (<jats:italic>n<\/jats:italic>\u00a0=\u00a010) and at baseline in 10 cirrhotic patients without thrombocytopenia; spleen size was measured at baseline in all patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Endotoxin and <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106 levels were significantly higher in patients with thrombocytopenia than in those without thrombocytopenia (2.76\u00a0\u00b1\u00a00.69 vs. 0.64\u00a0\u00b1\u00a00.09\u00a0EU\/ml; <jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001 and 24.26 \u00b1\u00a03.38 vs. 2.66\u00a0\u00b1\u00a00.74\u00a0pg\/ml; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001 respectively). Platelet counts were inversely correlated with endotoxin levels (<jats:italic>r\u00a0<\/jats:italic>=\u00a0\u22120.589; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.003), Child\u2010Pugh score (<jats:italic>r<\/jats:italic>\u00a0=\u00a0\u22120.625; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.001), <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106 levels (<jats:italic>r<\/jats:italic>\u00a0=\u00a0\u22120.464; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02) and spleen size (<jats:italic>r<\/jats:italic>\u00a0=\u00a0\u22120.455; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02) in patients with thrombocytopenia. Following rifaximin, platelet counts increased significantly (83\u00a0100\u00a0\u00b1\u00a09700 vs. 99\u00a0600\u00a0\u00b1\u00a011\u00a0200\/\u03bcl; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.006) in line with significant reductions in endotoxin (1.28\u00a0\u00b1\u00a00.41 vs. 2.54\u00a0\u00b1\u00a00.86\u00a0EU\/ml; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.005), <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20101 (3.1\u00a0\u00b1\u00a00.5 vs. 4.4 \u00b1\u00a01.2\u00a0pg\/ml; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04), <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106 (12.8\u00a0\u00b1\u00a02.5 vs. 21.1\u00a0\u00b1\u00a04.2\u00a0pg\/ml; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.01) and <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010\u03b1 (3.6\u00a0\u00b1\u00a01.3 vs. 5.8\u00a0\u00b1\u00a01.7; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.02) levels. Platelet count changes were correlated with the changes in endotoxin (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.573; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.04), <jats:styled-content style=\"fixed-case\">TNF<\/jats:styled-content>\u2010\u03b1 (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.554; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.05) and <jats:styled-content style=\"fixed-case\">IL<\/jats:styled-content>\u20106 (<jats:italic>r<\/jats:italic>\u00a0=\u00a00.495; <jats:italic>P<\/jats:italic>\u00a0=\u00a00.07) levels.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Rifaximin improves cirrhosis\u2010related thrombocytopenia and this could be related with the reduction of endotoxaemia.<\/jats:p><\/jats:sec>","DOI":"10.1111\/j.1478-3231.2011.02650.x","type":"journal-article","created":{"date-parts":[[2015,10,13]],"date-time":"2015-10-13T11:01:28Z","timestamp":1444734088000},"page":"467-475","source":"Crossref","is-referenced-by-count":49,"title":["Rifaximin improves thrombocytopenia in patients with alcoholic cirrhosis in association with reduction of endotoxaemia"],"prefix":"10.1111","volume":"32","author":[{"given":"Georgios N.","family":"Kalambokis","sequence":"first","affiliation":[{"name":"1<sup>st<\/sup> Division of Internal Medicine and Hepato\u2010Gastroenterology Unit University Hospital Ioannina Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasia","family":"Mouzaki","sequence":"additional","affiliation":[{"name":"Division of Hematology Department of Internal Medicine Medical School University of Patras, Patras 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