{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T16:15:50Z","timestamp":1783354550092,"version":"3.54.6"},"reference-count":18,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Aim: Rifaximin is a gut-selective antibiotic with minimal systemic absorption that exerts its effects primarily within the gastrointestinal tract. Beyond its antimicrobial activity, rifaximin has been shown to possess anti-inflammatory and immunomodulatory properties. Gastric intestinal metaplasia (GIM) is a premalignant lesion associated with chronic gastric inflammation and Helicobacter pylori infection and is considered an important step in gastric carcinogenesis. Given the regulatory effects of rifaximin on the gut microbiota and mucosal inflammation, its potential impact on gastric histopathological alterations remains poorly understood. This study aimed to evaluate the effects of rifaximin therapy on gastric histopathological findings, particularly gastric intestinal metaplasia. Methods: In this retrospective single-center study, patients who received rifaximin therapy for various gastrointestinal indications and underwent upper gastrointestinal endoscopy with gastric biopsies both before and after treatment were included. Demographic characteristics, rifaximin treatment data, and histopathological findings were obtained from hospital records. Pre- and post-treatment biopsy findings were compared with respect to gastric intestinal metaplasia, dysplasia, and Helicobacter pylori positivity. Results: A total of 80 patients (mean age: 62.4 \u00b1 11.9 years; 58.8% male) were included. Following rifaximin therapy, gastric intestinal metaplasia demonstrated significant regression (p &lt; 0.001). Complete regression was observed in 45 patients (56.2%), partial regression in 12 patients (15.0%), stable disease in 14 patients (17.5%), and progression in 9 patients (11.3%). Helicobacter pylori positivity decreased from 42.5% to 31.2% (p = 0.041), whereas no significant change was observed in dysplasia rates (p = 0.564). No significant correlation was found between biopsy interval and the degree of intestinal metaplasia regression (Spearman\u2019s r = \u22120.057, p = 0.617). Conclusions: Rifaximin therapy was associated with regression in both the presence and severity of gastric intestinal metaplasia. These findings provide preliminary evidence supporting further investigation of rifaximin in gastric intestinal metaplasia. However, the results should be considered hypothesis-generating, and larger prospective controlled studies are required to establish a causal relationship and further elucidate the underlying mechanisms.<\/jats:p>","DOI":"10.3390\/jcm15135282","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T14:56:42Z","timestamp":1783349802000},"page":"5282","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of Rifaximin, a Gut-Selective Antibiotic, on Gastric Intestinal Metaplasia: A Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2245-5941","authenticated-orcid":false,"given":"Gokhan","family":"Aydin","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Giresun University, Giresun 28200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bengisu","family":"Ulu Karasu","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Giresun University, Giresun 28200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selcuk","family":"Takir","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, Faculty of Medicine, Giresun University, Giresun 28200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Cumhur","family":"Dulger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology, Faculty of Medicine, Giresun University, Giresun 28200, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1111\/j.1751-2980.2011.00550.x","article-title":"The gastric precancerous cascade","volume":"13","author":"Correa","year":"2012","journal-title":"J. Dig. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1833","DOI":"10.1016\/j.cgh.2017.05.023","article-title":"Gastric Cancer as Preventable Disease","volume":"15","author":"Rugge","year":"2017","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.3748\/wjg.v22.i3.1311","article-title":"Helicobacter pylori associated gastric intestinal metaplasia: Treatment and surveillance","volume":"22","author":"Liu","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1053\/j.gastro.2019.12.003","article-title":"AGA Clinical Practice Guidelines on Management of Gastric Intestinal Metaplasia","volume":"158","author":"Gupta","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1136\/gutjnl-2017-314281","article-title":"Mucosal microbiome dysbiosis in gastric carcinogenesis","volume":"67","author":"Coker","year":"2018","journal-title":"Gut"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Yang, J., Zhou, X., Liu, X., Ling, Z., and Ji, F. (2021). Role of the Gastric Microbiome in Gastric Cancer: From Carcinogenesis to Treatment. Front. Microbiol., 12.","DOI":"10.3389\/fmicb.2021.641322"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1007\/s10620-020-06101-z","article-title":"Microbiome and Gastric Cancer","volume":"65","author":"Engstrand","year":"2020","journal-title":"Dig. Dis. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1159\/000081990","article-title":"Rifaximin, a poorly absorbed antibiotic: Pharmacology and clinical potential","volume":"51","author":"Scarpignato","year":"2005","journal-title":"Chemotherapy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1159\/000443361","article-title":"The Role of Antibiotics in Gut Microbiota Modulation: The Eubiotic Effects of Rifaximin","volume":"34","author":"Ponziani","year":"2016","journal-title":"Dig. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1016\/j.ejphar.2011.06.058","article-title":"Inhibition of NF-\u03baB by a PXR-dependent pathway mediates counter-regulatory activities of rifaximin on innate immunity in intestinal epithelial cells","volume":"668","author":"Mencarelli","year":"2011","journal-title":"Eur. J. Pharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1038\/ja.2014.106","article-title":"Rifaximin: Beyond the traditional antibiotic activity","volume":"67","author":"Calanni","year":"2014","journal-title":"J. Antibiot."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.dmpk.2019.01.002","article-title":"Rifamycin SV exhibits strong anti-inflammatory in vitro activity through pregnane X receptor stimulation and NF\u03baB inhibition","volume":"34","author":"Rosette","year":"2019","journal-title":"Drug Metab. Pharmacokinet."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4491","DOI":"10.3748\/wjg.v23.i25.4491","article-title":"Eubiotic properties of rifaximin: Disruption of the traditional concepts in gut microbiota modulation","volume":"23","author":"Ponziani","year":"2017","journal-title":"World J. Gastroenterol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Kaji, K., Saikawa, S., Takaya, H., Fujinaga, Y., Furukawa, M., Kitagawa, K., Ozutsumi, T., Kaya, D., Tsuji, Y., and Sawada, Y. (2020). Rifaximin Alleviates Endotoxemia with Decreased Serum Levels of Soluble CD163 and Mannose Receptor and Partial Modification of Gut Microbiota in Cirrhotic Patients. Antibiotics, 9.","DOI":"10.3390\/antibiotics9040145"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tjandra, D., Busuttil, R.A., and Boussioutas, A. (2023). Gastric Intestinal Metaplasia: Challenges and the Opportunity for Precision Prevention. Cancers, 15.","DOI":"10.3390\/cancers15153913"},{"key":"ref_16","first-page":"92","article-title":"Overview of Current Concepts in Gastric Intestinal Metaplasia and Gastric Cancer","volume":"14","author":"Jencks","year":"2018","journal-title":"Gastroenterol. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Zhang, S., Shen, Y., Liu, H., Zhu, D., Fang, J., Pan, H., and Liu, W. (2023). Inflammatory microenvironment in gastric premalignant lesions: Implication and application. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1297101"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Dumitru, I.G., Todor, S.B., Ichim, C., Helgiu, C., and Helgiu, A. (2025). A Literature Review on the Impact of the Gut Microbiome on Cancer Treatment Efficacy, Disease Evolution and Toxicity: The Implications for Hematological Malignancies. J. Clin. Med., 14.","DOI":"10.3390\/jcm14092982"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5282\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T15:30:12Z","timestamp":1783351812000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/13\/5282"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":18,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15135282"],"URL":"https:\/\/doi.org\/10.3390\/jcm15135282","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]}}}