{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T14:44:25Z","timestamp":1791816265429,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004731","name":"Natural Science Foundation of Zhejiang Province","doi-asserted-by":"publisher","award":["LTGD24H030001"],"award-info":[{"award-number":["LTGD24H030001"]}],"id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>\n                      Although rifaximin treatment achieves high remission rates in diarrhea\u2010predominant irritable bowel syndrome (IBS\u2010D), current therapeutic approaches remain ineffective in preventing disease recurrence. This study aimed to evaluate the relapse rates with Rifaximin after consolidation course with live\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Bacillus subtilis<\/jats:italic>\n                      <\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">\n                        <jats:italic>Enterococcus faecium<\/jats:italic>\n                      <\/jats:styled-content>\n                      capsules (Medilac\u2010S) and explore gut microbiota changes in these IBS\u2010D patients.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a multicenter, open\u2010label, randomized trial. Participants responded to 2\u2010week rifaximin were randomly assigned to receive Medilac\u2010S for 4\u2010week consolidation therapy or to no further treatment in a 2:1 ratio. The primary outcome is relapse rate. Secondary outcomes include IBS\u2010Symptom Severity Score, IBS\u2010quality of life, stool frequency and consistency, microbiota profiles, and adverse event incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      143 participants were randomized to Medilac\u2010S or control group. The relapse rate was significantly lower in Medilac\u2010S consolidation therapy group compared with patients receiving rifaximin only (40.00% [38\/95] vs. 58.33% [28\/48],\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.0378) at the end of follow\u2010up. Furthermore, we observed a higher\n                      <jats:italic>Firmicutes<\/jats:italic>\n                      to\n                      <jats:italic>Bacteroidota<\/jats:italic>\n                      ratio and an increased abundance of\n                      <jats:italic>Faecalibacterium<\/jats:italic>\n                      and\n                      <jats:italic>Streptococcus<\/jats:italic>\n                      in patients who experienced relapse. The Medilac\u2010S group achieved a significant reduction in bowel movement frequency (1.73\u2009\u00b1\u20090.75 vs. 2.53\u2009\u00b1\u20091.20,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and improvement of stool consistency (BSFS 4.38\u2009\u00b1\u20091.06 vs. 5.15\u2009\u00b1\u20090.95,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings demonstrate that consolidation therapy with Medilac\u2010S following clinical complete response to Rifaximin achieves sustained long\u2010term remission in IBS\u2010D, particularly in improvement of stool frequency\/consistency and effective relapse prevention.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/clinicaltrials.gov\/\">ClinicalTrials.gov<\/jats:ext-link>\n                      identifier: NCT04074421\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.70672","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T07:48:37Z","timestamp":1787039317000},"page":"3077-3088","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Consolidation Therapy of Probiotics With Rifaximin Prevent Relapse in Rifaximin\u2010Responsive Diarrhea\u2010Predominant Irritable Bowel Syndrome: A Multicenter Randomized Clinical Trial"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7022-5059","authenticated-orcid":false,"given":"Jing","family":"Zhong","sequence":"first","affiliation":[{"name":"Department of Gastroenterology the Second Affiliated Hospital, School of Medicine Zhejiang University  Hangzhou China"},{"name":"Institute of Gastroenterology Zhejiang University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengyang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology the Second Affiliated Hospital, School of Medicine Zhejiang University  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenwen","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology the Second Affiliated Hospital, School of Medicine Zhejiang University  Hangzhou China"},{"name":"Institute of Gastroenterology Zhejiang University  Hangzhou 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Gastroenterology Lishui Central Hospital, the Fifth Hospital Affiliated Wenzhou Medical  Lishui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1975-1862","authenticated-orcid":false,"given":"Xinli","family":"Mao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Taizhou Hospital of Zhejiang Province  Taizhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yabi","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Lishui People's Hospital  Lishui China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianzhong","family":"Sang","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology YuYao People's Hospital of Zhejiang Province  Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peifen","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Zhejiang Hospital  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linhua","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology the First People's Hospital of Huzhou  Zhejiang China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8283-084X","authenticated-orcid":false,"given":"Feng","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology First Affiliated Hospital of Jiaxing  Jiaxing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaqiang","family":"You","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Linping Campus Second Affiliated Hospital, Zhejiang University School of Medicine  Hangzhou 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