The gastrointestinal tract is a complex and dynamic network where an intricate and
mutualistic symbiosis modulates the relationship between the host and the microbiota in order to
establish and ensure gut homeostasis. Every day, thousands of compounds derived from food and
microorganisms come in contact with the intestinal mucosa. This interaction requires a complex
defense system that separates intestinal contents from the host tissues, regulates nutrient absorption,
and allows tolerance between the resident bacterial flora and the mucosal immune system, while
inhibiting translocation of infectious agents to the inner tissues. Unfavorable alteration of microbiota
composition has been implicated in hepatic, gastrointestinal, and perhaps also systemic disorders. In this scenario, gut
microbiota modulation represents an intriguing field and can be obtained by several approaches, including antibiotics, proand
pre-biotics supplementation. Among antibiotics, Rifaximin seems to be a promising antibiotic to treat conditions
related to gut microbiota imbalance and to potentially modulate intestinal homeostasis. This review focuses on what is
currently known regarding the possible role of Rifaximin in restoring normal gut immune physiology and a healthy gutliver
axis. Detailed mechanistic studies will improve the development of targeted therapies that may shape gut microflora
composition with the end goal of promoting gut health.
Keywords: Encephalopathy, gut barrier, gut-liver axis, gut microbiota, mucosal immunity, rifaximin.
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