Cammarota Giovanni, Ianiro Gianluca, Gasbarrini Antonio
Department of Internal Medicine, Division of Internal Medicine and Gastroenterology, A. Gemelly University Hospital, Rome, Italy.
J Clin Gastroenterol. 2014 Sep;48(8):693-702. doi: 10.1097/MCG.0000000000000046.
By systematic review, we assessed the impact of fecal microbiota transplantation (FMT) for the treatment of Clostridium difficile (CD)-associated diarrhea.
Fecal microbiota microbiota transplantation from a healthy donor into an individual with CD infection (CDI) can resolve symptoms.
We conducted systematic searches in PubMed, SCOPUS, Web of Science, and Cochrane Library. The last search was run on February 8, 2013. The following Medical Subject Headings terms and keywords were used alone or in combination: Clostridium difficile; Clostridium infection; pseudomembranous colitis; feces; stools; fecal suspension; fecal transplantation; fecal transfer; fecal infusion; microbiota; bacteriotherapy; enema; nasogastric tube; colonoscopy; gastroscopy; fecal donation; donor. A critical appraisal of the clinical research evidence on the effectiveness and safety of FMT for the treatment of patients with CD-associated diarrhea was made.
Twenty full-text case series, 15 case reports, and 1 randomized controlled study were included for the final analysis. Almost all patients treated with donors' fecal infusion experienced recurrent episodes of CD-associated diarrhea despite standard antibiotic treatment. Of a total of 536 patients treated, 467 (87%) experienced resolution of diarrhea. Diarrhea resolution rates varied according to the site of infusion: 81% in the stomach; 86% in the duodenum/jejunum; 93% in the cecum/ascending colon; and 84% in the distal colon. No severe adverse events were reported with the procedure.
FMT seems efficacious and safe for the treatment of recurrent CDI. Hospitals should encourage the development of fecal transplantation programs to improve therapy of local patients.
通过系统评价，我们评估了粪便微生物群移植（FMT）对艰难梭菌（CD）相关性腹泻治疗的影响。
将健康供体的粪便微生物群移植到患有CD感染（CDI）的个体中可缓解症状。
我们在PubMed、SCOPUS、科学网和考克兰图书馆进行了系统检索。最后一次检索于2013年2月8日进行。以下医学主题词和关键词单独或组合使用：艰难梭菌；梭菌感染；假膜性结肠炎；粪便；大便；粪便悬液；粪便移植；粪便转移；粪便输注；微生物群；细菌疗法；灌肠；鼻胃管；结肠镜检查；胃镜检查；粪便捐赠；供体。对FMT治疗CD相关性腹泻患者有效性和安全性的临床研究证据进行了批判性评价。
最终分析纳入了20个全文病例系列、15个病例报告和1项随机对照研究。几乎所有接受供体粪便输注治疗的患者尽管接受了标准抗生素治疗，仍出现CD相关性腹泻复发。在总共536例接受治疗的患者中，467例（87%）腹泻得到缓解。腹泻缓解率根据输注部位而异：胃为81%；十二指肠/空肠为86%；盲肠/升结肠为93%；远端结肠为84%。该操作未报告严重不良事件。
FMT治疗复发性CDI似乎有效且安全。医院应鼓励开展粪便移植项目以改善当地患者的治疗。
