Khoruts Alexander, Rank Kevin M, Newman Krista M, Viskocil Kimberly, Vaughn Byron P, Hamilton Matthew J, Sadowsky Michael J
Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; BioTechnology Institute, University of Minnesota, Minneapolis, Minnesota.
Division of Gastroenterology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Clin Gastroenterol Hepatol. 2016 Oct;14(10):1433-8. doi: 10.1016/j.cgh.2016.02.018. Epub 2016 Feb 22.
BACKGROUND & AIMS: A significant fraction of patients with recurrent Clostridium difficile infections (CDI) have inflammatory bowel disease (IBD). Fecal microbiota transplantation (FMT) can break the cycle of CDI recurrence and can be performed without evaluation of the colon. We evaluated the efficacy of colonoscopic FMT in patients with and without IBD, and whether we could identify IBD in patients during this procedure.
We collected clinical meta-data and colonoscopy results from 272 consecutive patients that underwent FMT for recurrent CDI at the University of Minnesota from 2008 through 2015. Patients had at least 2 spontaneous relapses of CDI following their initial episode and did not clear the infection after 1 extended antibiotic regimen. We collected random mucosal biopsies from patients' right colons to identify lymphocytic or collagenous colitis during the FMT procedure. Failure or success in clearing CDI was determined within or at 2 months after the FMT.
Of patients undergoing FMT, 15% had established IBD and 2.6% were found to have IBD during the FMT procedure. A single colonoscopic FMT cleared CDI from 74.4% of patients with IBD and 92.1% of patients without IBD (P = .0018). Patients had similar responses to FMT regardless of immunosuppressive therapy. More than one-quarter of patients with IBD (25.6%) had a clinically significant flare of IBD after FMT. Lymphocytic colitis was documented in 7.4% of patients with endoscopically normal colon mucosa; only 3 of these patients (20%) required additional treatment for colitis after clearance of CDI.
Based on an analysis of 272 patients, FMT is somewhat less effective in clearing recurrent CDI from patients with IBD, compared with patients without IBD, regardless of immunosuppressive therapy. More than 25% of patients with IBD have a disease flare following FMT. Lymphocytic colitis did not affect the outcome of FMT, but a small fraction of these patients required pharmacologic treatment after the procedure.
相当一部分复发性艰难梭菌感染（CDI）患者患有炎症性肠病（IBD）。粪便微生物群移植（FMT）可打破CDI复发的循环，且无需对结肠进行评估即可实施。我们评估了结肠镜下FMT对有或无IBD患者的疗效，以及在此过程中是否能识别出IBD患者。
我们收集了2008年至2015年在明尼苏达大学因复发性CDI接受FMT的272例连续患者的临床元数据和结肠镜检查结果。患者在首次发作后至少有2次CDI自发复发，且在1个延长的抗生素疗程后感染未清除。我们在FMT过程中从患者右半结肠采集随机黏膜活检样本，以识别淋巴细胞性或胶原性结肠炎。在FMT期间或之后2个月内确定清除CDI的失败或成功情况。
在接受FMT 的患者中，15%已确诊IBD，2.6%在FMT过程中被发现患有IBD。单次结肠镜下FMT使74.4%的IBD患者和92.1%的非IBD患者的CDI得到清除（P = 0.0018）。无论免疫抑制治疗情况如何，患者对FMT的反应相似。超过四分之一的IBD患者（25.6%）在FMT后出现临床上显著的IBD发作。7.4%的结肠黏膜内镜检查正常的患者被记录有淋巴细胞性结肠炎；这些患者中只有3例（20%）在CDI清除后需要额外的结肠炎治疗。
基于对272例患者的分析，与无IBD的患者相比，无论免疫抑制治疗情况如何，FMT在清除IBD患者的复发性CDI方面效果稍差。超过25%的IBD患者在FMT后出现疾病发作。淋巴细胞性结肠炎不影响FMT的结果，但这些患者中有一小部分在术后需要药物治疗。
