Rifaximin for the Secondary Prevention of Recurrent Pouchitis

Inclusion Criteria:

• Informed consent will be obtained before any study-related procedures

• Age > 18 and <75 years

• Participants with a proven history of ulcerative colitis and history of 1,2,modified -2 or 3 stage Ileal pouch anal anastomosis (IPAA) and ileostomy takedown

• Diagnosis of initial episode of pouchitis within the first 12 months after ileostomytakedown/final stage of IPAA surgery

Exclusion Criteria:

• Known hypersensitivity to rifaximin or its metabolites

• Known Crohn's disease

• History of perianal fistula

• Known incontinence due to anal sphincter dysfunction

• Known irritable pouch syndrome

• Active ongoing pelvic infection/sepsis at baseline visit

• New onset of high bowel frequency in the setting of acute pouchitis in the first 4weeks after IPAA

• Known Clostridoides difficile infection

• Need for antibiotic long-term therapy (e.g. doxycycline for acne)

• Known active Hepatitis B, C, HIV

• Clinically significant liver disease (Primary Sclerosing Cholangitis with LFT's <1.5upper limit of normal can be included)

• Severe hepatic impairment, defined as Child-Pugh Class C

• Concomitant use of p-glycoprotein (P-gp) inhibitors (e.g. cyclosporine)

• Known decreased kidney function with a glomerular filtration rate <60 ml/min/1.732

• Fecal microbiota transplantation within 16 weeks before ileostomy takedown

• History of malignancy, except for basal cell carcinoma, non-metastatic squamous cellcarcinoma of the skin, or prior malignancy with curative therapy completed at least 5 years prior to Screening and no recurrence.

• Clinically significant laboratory results at screening or baseline, as judged by theInvestigator from local testing.

• Female who is pregnant, breast-feeding or intends to become pregnant or is ofchild-bearing potential and not using a highly effective contraceptive method. Womenof child-bearing potential must have a negative urine pregnancy test prior to drugbeing dispensed.

• Participation in any clinical trial of an approved or non-approved investigationalmedicinal product within 30 days before screening.

• Any disorder, which in the investigator's opinion might jeopardize participant'ssafety or compliance with the protocol.