Morken Mette Helvik, Valeur Jørgen, Norin Elisabeth, Midtvedt Tore, Nysaeter Gunnar, Berstad Arnold
Institute of Medicine, University of Bergen, Bergen, Norway.
Scand J Gastroenterol. 2009;44(11):1296-303. doi: 10.3109/00365520903274401.
OBJECTIVE. Intestinal infection with Giardia lamblia may lead to therapy-resistant, long-lasting post-giardiasis irritable bowel syndrome (IBS). We report two open pilot studies aiming to treat this condition, using either antibiotics or bacterio-therapy. MATERIAL AND METHODS. Twenty-eight patients with persistent abdominal symptoms, following clearance of G. lamblia infection, were investigated. Eighteen received treatment with rifaximin plus metronidazole (8-10 days) whereas 10 received a suspension of live faecal flora, installed into the duodenum during gastro-duodenoscopy. Customary abdominal symptoms and symptoms following a lactulose breath test were quantified by questionnaires. Hydrogen and methane production after lactulose were analysed in expired air and excretion of fat and short-chain fatty acids (SCFAs) was examined in faeces. RESULTS. As compared with pre-treatment values, total customary symptom scores were barely significantly reduced (p = 0.07) after antibiotics, but were highly significantly reduced (p = 0.0009) after bacterio-therapy. However, symptom improvement following bacterio-therapy did not persist 1 year later. Hydrogen breath excretion was slightly reduced after antibiotics, but not after bacterio-therapy. Compared with healthy persons, faecal excretion of fat was significantly increased in Giardia-cured patients. SCFAs were increased in the bacterio-therapy group, and were not influenced by therapy. CONCLUSIONS. Both antibiotics and bacterio-therapy were ineffective with respect to cure of post-giardiasis IBS. High faecal excretion of fat and SCFAs suggests that intestinal malabsorption of fat and carbohydrates may play a role in the IBS-like complaints of these patients.
目的。感染蓝氏贾第鞭毛虫可能会导致治疗抵抗性、持续时间长的贾第虫病后肠易激综合征（IBS）。我们报告两项开放性初步研究，旨在使用抗生素或细菌疗法治疗这种疾病。材料与方法。对28例蓝氏贾第鞭毛虫感染清除后仍有持续性腹部症状的患者进行了调查。18例患者接受利福昔明加甲硝唑治疗（8 - 10天），而10例患者在胃肠十二指肠镜检查期间接受了十二指肠内注入的活粪便菌群悬液治疗。通过问卷调查对常规腹部症状和乳果糖呼气试验后的症状进行量化。分析呼出气体中乳果糖后的氢气和甲烷产生情况，并检测粪便中脂肪和短链脂肪酸（SCFA）的排泄情况。结果。与治疗前值相比，抗生素治疗后总常规症状评分仅略有显著降低（p = 0.07），但细菌疗法后显著降低（p = 0.0009）。然而，细菌疗法后的症状改善在1年后并未持续。抗生素治疗后氢气呼气排泄略有减少，但细菌疗法后没有。与健康人相比，贾第虫治愈患者的粪便脂肪排泄显著增加。细菌疗法组的SCFA增加，且不受治疗影响。结论。抗生素和细菌疗法对治疗贾第虫病后IBS均无效。粪便中脂肪和SCFA的高排泄表明脂肪和碳水化合物的肠道吸收不良可能在这些患者的IBS样症状中起作用。
