Stallmach Andreas, Grunert Philip, Pieper Dietmar, Steube Arndt
Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie, Infektiologie, Interdisziplinäre Endoskopie), Universitätsklinikum Jena, Germany.
Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.
Z Gastroenterol. 2019 Jul;57(7):834-842. doi: 10.1055/a-0874-6603. Epub 2019 Apr 15.
Although the pathogenesis of ulcerative colitis (UC) remains elusive, substantial progress in understanding its development and progression has been achieved in the past decades, and novel effective treatment strategies have been developed. Changes in gut microbiota, environmental triggers, deregulation of immunological responses, and genetic predisposition have been identified as pathogenic key factors. There are several lines of clinical observations, which support a close connection of altered gut microbiota with the development and course of UC. Despite a plethora of microbiota alterations in UC, it is currently unclear whether the observed changes in inflammation are cause or effect of the altered microbiota state.Fecal microbiota transplantation (FMT) provides a novel, perhaps complementary, strategy to restore gut microbial diversity, bacterial richness, and microbial homeostasis in UC. FMT is an already established treatment option for recurrent Clostridioides difficile infection, and several case series and randomized controlled trials have described its use in UC. In this review, we evaluate recent efficacy and safety data on FMT for UC, discuss possible pitfalls and show possible areas of future development. Although FMT could become a promising treatment modality for UC, based on currently available data, FMT should be only performed in clinical trials as controlled studies focusing on long-term outcomes and safety are warranted.
尽管溃疡性结肠炎（UC）的发病机制仍不清楚，但在过去几十年里，在了解其发展和进展方面已取得了重大进展，并且已经开发出了新的有效治疗策略。肠道微生物群的变化、环境触发因素、免疫反应失调和遗传易感性已被确定为致病的关键因素。有几条临床观察线索支持肠道微生物群的改变与UC的发生和病程密切相关。尽管UC中存在大量微生物群改变，但目前尚不清楚观察到的炎症变化是微生物群状态改变的原因还是结果。粪便微生物群移植（FMT）为恢复UC患者肠道微生物多样性、细菌丰富度和微生物稳态提供了一种新的、或许是补充性的策略。FMT是复发性艰难梭菌感染已确立的治疗选择，并且有几个病例系列和随机对照试验描述了其在UC中的应用。在本综述中，我们评估了FMT治疗UC的近期疗效和安全性数据，讨论了可能存在的问题，并展示了未来可能的发展领域。尽管FMT可能成为UC一种有前景的治疗方式，但基于目前可得的数据，FMT应仅在临床试验中进行，因为有必要开展关注长期结局和安全性的对照研究。
