Weisheit Bianca, Bethke Birgit, Stolte Manfred
Institut für Pathologie, Klinikum Bayreuth, Bayreuth, Germany.
Scand J Gastroenterol. 2007 Dec;42(12):1422-7. doi: 10.1080/00365520701245629.
Colonization of the colorectal mucosa with spirochetes is very rare. Owing to the small number of cases, it is not clear from the currently available publications whether spirochetes colonizing the colorectal mucosa are harmless commensals or pathogenic organisms. Furthermore, the reported complaints of these patients cannot be pooled to identify a characteristic complex of symptoms. The aim of the present work was to describe the symptoms associated with intestinal spirochetosis in a population of 209 patients, and to elucidate the effect of antibiotic treatment on these symptoms.
A total of 209 carefully processed questionnaires providing information on the symptoms, treatment and post-treatment symptoms of patients with spirochetosis were evaluated statistically and descriptively with the aid of the SPSS program, and the results were compared with those reported in the currently available literature.
Of the 209 patients 168 (80.4%) were males, and the average age of the entire population at establishment of the diagnosis was 50.75 years. The most common symptoms reported were abdominal pain (46%), diarrhoea (51%) and alternating diarrhoea and constipation (13%). In this population, homosexuality and HIV infection played only a small role (6.5% homosexual patients, 3.8% HIV infected). In 72 of the 84 patients who received treatment (86%), the antibiotic employed was metronidazole, and the symptoms improved in 44 of the 84 patients (5%). Twenty-six of the 84 patients (30.9%) were investigated by colonoscopy/biopsy after receiving medical treatment. Biopsies in 20 of these patients no longer revealed infection with spirochetes, and symptoms were found to have improved in 11 of the 20 patients (55%).
If intestinal spirochetosis is diagnosed to be the sole intestinal pathology in symptomatic patients, the bacteria should be eradicated with metronidazole and a colonoscopy/biopsy follow-up performed, where indicated, in patients with persisting symptoms. Significant results regarding symptoms and treatment of intestinal spirochetosis can be achieved only in a prospective, placebo-controlled, randomized, crossover study. In view of the low prevalence of this condition, such a study is difficult to implement.
结肠黏膜被螺旋体定植的情况非常罕见。由于病例数量较少，目前的文献尚不清楚定植于结肠黏膜的螺旋体是无害的共生菌还是致病微生物。此外，这些患者报告的症状无法汇总以确定特征性的症状组合。本研究的目的是描述209例患者中与肠道螺旋体病相关的症状，并阐明抗生素治疗对这些症状的影响。
借助SPSS程序对总共209份经过仔细处理的问卷进行统计和描述性评估，这些问卷提供了螺旋体病患者的症状、治疗及治疗后症状的信息，并将结果与现有文献报道的结果进行比较。
209例患者中，168例（80.4%）为男性，确诊时整个人群的平均年龄为50.75岁。报告的最常见症状为腹痛（46%）、腹泻（51%）和腹泻与便秘交替出现（13%）。在该人群中，同性恋和HIV感染仅起很小的作用（同性恋患者占6.5%，HIV感染者占3.8%）。84例接受治疗的患者中有72例（86%）使用的抗生素为甲硝唑，84例患者中有44例（5%）症状有所改善。84例患者中有26例（30.9%）在接受药物治疗后接受了结肠镜检查/活检。其中20例患者的活检不再显示螺旋体感染，20例患者中有11例（55%）症状有所改善。
如果在有症状的患者中诊断出肠道螺旋体病是唯一的肠道病变，应用甲硝唑根除细菌，并在有持续症状的患者中根据需要进行结肠镜检查/活检随访。关于肠道螺旋体病的症状和治疗，只有在前瞻性、安慰剂对照、随机、交叉研究中才能取得显著结果。鉴于这种疾病的患病率较低，这样的研究难以实施。
