Efficacy of Rifaximin in Relieving Symptoms of IBS-D: Experience from a Public Hospital in Pakistan

Background: Irritable Bowel Syndrome with Diarrhea (IBS-D) is a prevalent and distressing gastrointestinal disorder, particularly in South Asia, where evidence for rifaximin’s efficacy remains limited. Objective: This study aimed to evaluate the efficacy and safety of rifaximin compared to placebo in improving symptoms and quality of life among patients with IBS-D, focusing on symptom severity, bloating, urgency, and adverse events. Methods: A double-blinded, randomized, placebo-controlled trial was conducted among adults aged 18–65 years at DHQ Hospital Gujranwala, Pakistan (n = 120), meeting Rome IV criteria for IBS-D and with IBS Symptom Severity Score (IBS-SSS) >175. Participants were randomly assigned to rifaximin 550 mg or placebo, thrice daily for 14 days, and followed for 12 weeks. Symptom severity and secondary outcomes were assessed using IBS-SSS and structured symptom scales. Ethical approval was obtained from the Institutional Review Board of Gujranwala Medical College, following the Helsinki Declaration. Data were analyzed using SPSS v26; between-group differences were assessed with t-tests, chi-square tests, and risk ratios, with a significance threshold of p<0.05. Results: At week 4, 80.0% of the rifaximin group achieved ≥50-point reduction in IBS-SSS compared to 31.7% in placebo (p<0.001; RR 2.52, 95% CI 1.75–3.64), with sustained relief at week 12 (71.7% vs. 26.7%, p<0.001). Bloating and urgency improvements were significantly higher in the rifaximin group. Adverse events were mild and infrequent in both groups. Conclusion: Rifaximin is a highly effective and well-tolerated therapy for IBS-D in public sector clinical settings, offering substantial symptom relief and improved patient outcomes. These findings support its routine use in resource-constrained healthcare environments and highlight the need for continued research on long-term management strategies.