Prantera Cosimo, Scribano Maria Lia
Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy.
Curr Opin Gastroenterol. 2009 Jul;25(4):329-33. doi: 10.1097/MOG.0b013e32832b20bf.
To summarize recent evidence on the role of intestinal bacteria in inflammatory bowel diseases, and of antibiotics and probiotics in their treatment. The implications connected with the use of antibiotics are also examined.
The hypothesis that Mycobacterium paratuberculosis could be a causative agent of Crohn's disease has not been confirmed by a large trial on symptomatic patients treated by a combination of antibiotics active against this bacterium. An increased number of adherent-invasive Escherichia coli have been found in the intestinal tissue of patients with Crohn's disease, but their role in the pathogenesis of this condition remains to be defined. The combination of metronidazole and azathioprine, associating the effects of a reduced bacterial load with immunosuppression, appears to be a therapeutic option to decrease the recurrence of postoperative Crohn's disease in high-risk patients. However, concerns are raised by the possibility that antibiotics may induce disease relapse due to Clostridium difficile infection.
Recent literature provides increasing support for the use of antibiotics in Crohn's disease, although the side effects limit their long-term use. The efficacy of antibiotics in ulcerative colitis is not confirmed by the available literature, except in severe colitis. More trials are needed to support the use of probiotics as therapy in inflammatory bowel disease.
总结近期关于肠道细菌在炎症性肠病中的作用，以及抗生素和益生菌在其治疗中的作用的证据。还研究了与使用抗生素相关的影响。
一项针对有症状患者使用对该细菌有效的抗生素联合治疗的大型试验未证实副结核分枝杆菌可能是克罗恩病病原体这一假说。在克罗恩病患者的肠道组织中发现了数量增加的黏附侵袭性大肠杆菌，但其在该病发病机制中的作用仍有待确定。甲硝唑和硫唑嘌呤联合使用，将细菌载量降低的效果与免疫抑制作用相结合，似乎是降低高危患者术后克罗恩病复发率的一种治疗选择。然而，抗生素可能因艰难梭菌感染导致疾病复发，这引发了人们的担忧。
近期文献越来越支持在克罗恩病中使用抗生素，尽管其副作用限制了它们的长期使用。除了在重症结肠炎中，现有文献未证实抗生素在溃疡性结肠炎中的疗效。需要更多试验来支持将益生菌用作炎症性肠病的治疗方法。
