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At the time, Catalonia did not yet exist as a political entity, though the use of this term seems to acknowledge Catalonia as a cultural or geographical entity. The first reference to Catalonia and the Catalans appears in the Liber maiolichinus de gestis Pisanorum illustribus, a Pisan chronicle (written between 11) of the conquest of Majorca by a joint force of Italians, Catalans, and Occitans.

Today, the term Principat (Principality) is used primarily to refer to the autonomous community of Catalonia in Spain, as distinct from the other Catalan Countries, and usually including the historical region of Roussillon in Southern France. The term Principality of Catalonia was official until the 1830s, when the Spanish government implemented the centralized provincial division, but remained in popular and informal contexts. Between the 13th and the 18th centuries, it was bordered by the Kingdom of Aragon to the west, the Kingdom of Valencia to the south, the Kingdom of France and the feudal lordship of Andorra to the north and by the Mediterranean Sea to the east. During most of its history it was in dynastic union with the Kingdom of Aragon, constituting together the Crown of Aragon. Hepatology published by Wiley Periodicals LLC on behalf of American Association for the Study of Liver Diseases.The Principality of Catalonia ( Catalan: Principat de Catalunya Occitan: Principat de Catalonha Spanish: Principado de Cataluña Latin: Principatus Cathaloniæ) was a medieval and early modern state in the northeastern Iberian Peninsula.

The results of double-blinded, adequately powered randomized clinical trials assessing the effect of rifaximin, alone or in combination with other drugs, on hard clinical endpoints, such as decompensation of cirrhosis, acute-on-chronic liver failure, and mortality, are therefore eagerly awaited. It clearly emerges that, because of its potential activity on multiple pathogenic events, the efficacy of rifaximin in the prevention or management of complications other than HE deserves to be investigated extensively. The present review deals in the first part with the potential impact of rifaximin on pathogenic mechanisms in liver diseases, whereas in the second part, its clinical effects are critically discussed.

However, the use of rifaximin for prevention or treatment of other complications, including spontaneous bacterial peritonitis or other bacterial infections, is not accepted because evidence by clinical trials is still very weak. In the last decade, experimental and clinical evidence suggest that rifaximin could have other beneficial effects on the course of cirrhosis by modulating the gut microbiome and affecting the gut-liver axis, which in turn can interfere with major events of the pathophysiological cascade underlying decompensated cirrhosis, such as systemic inflammatory syndrome, portal hypertension, and bacterial infections. Rifaximin is currently used worldwide in patients with cirrhosis for preventing recurrent HE because its efficacy and safety have been proven by large randomized clinical trials. Rifaximin is an oral nonsystemic antibiotic with minimal gastrointestinal absorption and broad-spectrum antibacterial activity covering both gram-positive and gram-negative organisms.

13 Virginia Commonwealth University Medical Center, Richmond, VA.

12 Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.

11 Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark.

10 Hospital Beaujon, APHP, Paris, France.

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9 Royal Free Hospital, University College London, London, United Kingdom.8 University Hospital of Padova, Padova, Italy.7 EF-CLIF, Barcelona, Catalonia, Spain.6 Goethe-University - Frankfurt am Main, Frankfurt am Main, Germany.5 Amsterdam University Medical Centers, Amsterdam, the Netherlands.4 Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, University of Torino, Turin, Italy.3 Hospital Clinic of Barcelona, University of Barcelona, IDIBAPS, CIBEReHD, Barcelona, Catalonia, Spain.2 Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIEREHD, Barcelona, Catalonia, Spain.Orsola-Malpighi di Bologna, Bologna, Italy. 1 University of Bologna, University Hospital S.

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