Cheng Yao-Wen, Fischer Monika
Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Gastroenterology, Department of Medicine, Indiana University School of Medicine, 550 N. University Blvd, Suite 1602, Indianapolis, IN, 46202, USA.
Curr Treat Options Gastroenterol. 2017 Sep;15(3):349-362. doi: 10.1007/s11938-017-0143-1.
PURPOSE OF REVIEW: This article will review current literature describing fecal microbiota transplantation (FMT) in the treatment of various diseases, and its potential role in elderly patients (age ≥ 65 years).
Research on FMT has blossomed in the last decade and its pivotal role in the treatment of recurrent Clostridium difficile infection (CDI) has been recognized by the American College of Gastroenterology in the latest guidelines. There is also emerging evidence that FMT may be beneficial in the treatment of severe and/or complicated CDI refractory to medical therapy, resulting in decreased rates of colectomy and mortality. In the elderly, CDI is associated with markedly higher rates of mortality and colectomy; outcomes are even worse when patients have underlying inflammatory bowel disease (IBD). While the majority of patients who receive FMT for CDI are older, only a handful of studies focused specifically on FMT treatment outcomes and safety in this age group. Current data corroborate the efficacy and safety profile of FMT, while also supporting its use for recurrent, severe, and/or complicated CDI in the elderly population. FMT is recommended for the treatment of recurrent, severe, and/or complicated CDI in patients older than 65 years of age. It may be prudent to offer FMT earlier in the disease course, possibly after just the second recurrence and for the first episode of severe CDI to avert complications including colectomy and end-organ failure that elderly patients are more prone to developing.
综述目的：本文将综述描述粪便微生物群移植（FMT）治疗各种疾病的当前文献，及其在老年患者（年龄≥65岁）中的潜在作用。
过去十年中，关于FMT的研究蓬勃发展，美国胃肠病学会在最新指南中认可了其在治疗复发性艰难梭菌感染（CDI）中的关键作用。也有新证据表明，FMT可能有益于治疗对药物治疗难治的严重和/或复杂性CDI，从而降低结肠切除术和死亡率。在老年人中，CDI与明显更高的死亡率和结肠切除术发生率相关；当患者患有潜在的炎症性肠病（IBD）时，结局更差。虽然大多数接受FMT治疗CDI的患者年龄较大，但只有少数研究专门关注该年龄组FMT的治疗结局和安全性。当前数据证实了FMT的有效性和安全性，同时也支持其用于老年人群复发性、严重和/或复杂性CDI的治疗。对于65岁以上复发性、严重和/或复杂性CDI患者，推荐使用FMT。在疾病过程中更早地提供FMT可能是谨慎的做法，可能在第二次复发后以及严重CDI的首次发作时，以避免老年患者更容易发生的包括结肠切除术和终末器官衰竭在内的并发症。
