Promising novel treatment option for functional dyspepsia

A proton-pump inhibitor (PPI) plus rifaximin was associated with improved health outcomes compared with PPI monotherapy in patients with functional dyspepsia. The authors suggested that this observed benefit may be related to reduced levels of hydrogen sulphide-producing bacteria and favourable modulation of the oral microbiota.

The open-label, randomised trial included participants with functional dyspepsia who received 4 weeks of treatment with the PPI pantoprazole plus the locally acting gut antibiotic rifaximin (n=48) or pantoprazole alone (n=48). The primary endpoint was the symptom relief rate, defined as a reduction of ≥1 points in the mean score of key symptoms on the Patient Assessment of Upper Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) scale from baseline to week 8. Dr Jiaqi Gao (Peking University Third Hospital, China) presented the results [1].

The symptom relief rate was 77.1% in the combination arm and 47.9% in the monotherapy arm, meeting the primary endpoint (P<0.001; see Figure). “Participants in the experimental arm also showed better outcomes with respect to upper abdominal discomfort, bloating, and post-prandial fullness,” said Dr Gao. Furthermore, there was no difference in adverse event rates between the 2 arms. Additional analyses indicated that the observed differences in clinical outcomes may be explained by a reduction in hydrogen sulphide-producing bacteria and beneficial changes in the oral microbiota in participants treated with rifaximin.

Figure: Higher symptom relief rates of dual therapy 4 weeks post treatment [1]



PPI, proton-pump inhibitor; RIF, rifaximin.

“In the future, we need to look deeper into the mechanisms and roles of key bacteria to unravel their contribution to symptoms of functional dyspepsia and duodenal inflammation,” Dr Gao concluded.

1. Zhu L, et al. Impact of combined proton-pump inhibitor and rifaximin therapy in patients with functional dyspepsia: a randomised controlled trial. LB16, Latest news: From top to bottom, UEG Week, 4–7 October 2025, Berlin, Germany.

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Posted on 1 December 20251 December 2025