Various environmental factors affecting the human microbiota may lead to gut microbial imbalance and to the development of pathologies. Alterations of gut microbiota have been firmly implicated in digestive diseases such as hepatic encephalopathy, irritable bowel syndrome and diverticular disease. However, while these three conditions may all be related to dysfunction of the gut-liver-brain axis, the precise pathophysiology appears to differ somewhat for each. Herein, current knowledge on the pathophysiology of hepatic encephalopathy, irritable bowel syndrome, and diverticular disease are reviewed, with a special focus on the gut microbiota modulation associated with these disorders during therapy with rifaximin. In general, the evidence for the efficacy of rifaximin in hepatic encephalopathy appears to be well consolidated, although it is less supported for irritable bowel syndrome and diverticular disease. We reviewed current clinical practice for the management of these clinical conditions and underlined the desirability of more real-world studies to fully understand the potential of rifaximin in these clinical situations and obtain even more precise indications for the use of the drug.

2 Gastroenterology Department Centre of Postgraduate Medical Education Warsaw; Gastroenterology Department Bielanski Hospital Warsaw Poland

2 Internal Clinic University Hospital of L Pasteur and Medical faculty of P J Šafarik University Košice Slovakia

CEMAD Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome; Università Cattolica del Sacro Cuore Rome Italy

Clinical and Research Centre for Inflammatory Bowel Diseases ISCARE IVF Clinical Center Českomoravská Prague Czech Republic

Department of Gastroenterology and Digestive Endoscopy Masaryk Memorial Cancer Institute Brno; Department of Comprehensive Cancer Care Masaryk Memorial Cancer Institute and Faculty of Medicine Masaryk University Brno Czech Republic

Department of Gastroenterology and Hepatology Wroclaw Medical University Wroclaw Poland

Department of Gastroenterology Nemocnica Bory Penta Hospitals Bratislava Slovakia

Department of Visceral Surgery and Medicine Inselspital Bern University Hospital Bern Switzerland

Digestive Physiology Unit and Motility Lab University of Veracruz Veracruz Mexico

Gastroenterology Department Hospital Clinic of Barcelona University of Barcelona Barcelona; Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain

Gastroenterology Department Hospital da Senhora da Oliveira Guimarães Portugal and Life Braga; Health Sciences Research Institute School of Medicine University of Minho Braga; ICVS 3B's PT Government Associate Laboratory Guimarães Braga Portugal

Gastroenterology department Mohamed Taher Maamouri Hospital Nabeul; University of Tunis El Manar Faculty of Medicine of Tunis Tunisia

Internal Diseases Propedeutics Gastroenterology and Hepatology Sechenov 1st Moscow State Medical University Moscow Russia

Iuliu Hatieganu University of Medicine and Pharmacy Cluj County Clinical Emergency Hospital Cluj Napoca Romania

Laboratory of Digestive Physiology and Motility Medical Biological Research Institute of the Universidad Veracruzana Veracruz Mexico

Mechnikov North Western State Medical University Saint Petersburg Russia

Serviço de gastrenterologia hospital da luz Lisboa and faculdade de medicina da universidade de Lisboa Lisbon Portugal

UCM Digestive Diseases and ciberehd Virgen del Rocío University Hospital Institute of Biomedicine of Seville Department of Medicine University of Seville Seville Spain

Università Cattolica del Sacro Cuore Rome; Internal Medicine and Gastroenterology CEMAD Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy

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