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[粪便微生物群移植“粪便移植”的使用建议:奥地利胃肠病学和肝病学会(ÖGGH)与奥地利传染病和热带医学学会合作达成的共识]

[Recommendations for the use of faecal microbiota transplantation "stool transplantation": consensus of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) in cooperation with the Austrian Society of Infectious Diseases and Tropical Medicine].

作者信息

Kump P K, Krause R, Steininger C, Gröchenig H P, Moschen A, Madl C, Novacek G, Allerberger F, Högenauer C

机构信息

Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz.

Sektion Infektiologie und Tropenmedizin, Universitätsklinik für Innere Medizin, Medizinische Universität Graz.

出版信息

Z Gastroenterol. 2014 Dec;52(12):1485-92. doi: 10.1055/s-0034-1385562. Epub 2014 Dec 4.

Abstract

The intestinal microbiota has a pivotal role in the maintenance of health of the human organism, especially in the defense against pathogenic microorganisms. Alterations in the microbiota, also termed dysbiosis, seem to be involved in the pathogenesis of a variety of intestinal and extraintestinal diseases. Fecal microbiota transplantation (FMT), also known as stool transplantation, is a therapeutic procedure aiming at restoring an altered intestinal microbiota by administration of stool microorganisms from a healthy donor into the intestinal tract of a patient. FMT is most commonly used for recurrent forms of Clostridium difficile infections (CDI). There are currently many cohort studies in a large number of patients and a randomized controlled trial showing a dramatic effect of FMT for this indication. Therefore FMT is recommended by international medical societies for the treatment of recurrent CDI with high scientific evidence. Other potential indications are the treatment of fulminant CDI or the treatment of inflammatory bowel diseases. In the practical utilization of FMT there are currently several open questions regarding the screening of stool donors, the processing of stool and the mode of FMT application. Different modes of FMT application have been described, the application into the colon has to be preferred due to less reported side effects than the application into the upper gastrointestinal tract. So far only very few side effects due to FMT have been reported, nevertheless the use and risks of FMT are currently intensely debated in the medical community. This consensus report of the Austrian society of gastroenterology and hepatology (ÖGGH) in cooperation with the Austrian society of infectious diseases and tropical medicine provides instructions for physicians who want to use FMT which are based on the current medical literature.

摘要

肠道微生物群在维持人体健康方面起着关键作用,尤其是在抵御病原微生物方面。微生物群的改变,也称为生态失调,似乎与多种肠道和肠道外疾病的发病机制有关。粪便微生物群移植(FMT),也称为粪便移植,是一种治疗程序,旨在通过将健康供体的粪便微生物给予患者肠道来恢复改变的肠道微生物群。FMT最常用于复发性艰难梭菌感染(CDI)。目前有许多针对大量患者的队列研究和一项随机对照试验表明FMT对该适应症有显著效果。因此,国际医学协会推荐FMT用于治疗复发性CDI,有很高的科学依据。其他潜在适应症是暴发性CDI的治疗或炎症性肠病的治疗。在FMT的实际应用中,目前在粪便供体的筛选、粪便的处理以及FMT的应用方式方面存在几个未解决的问题。已经描述了不同的FMT应用方式,由于与上消化道应用相比副作用报道较少,结肠应用更受青睐。到目前为止,FMT引起的副作用报道很少,然而FMT的使用和风险目前在医学界仍存在激烈争论。奥地利胃肠病学和肝病学会(ÖGGH)与奥地利传染病和热带医学学会合作发布的这份共识报告为希望使用FMT的医生提供了基于当前医学文献的指导。

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