Division of Colon and Rectal Surgery, University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, 67 Belmont Street, Worcester, MA, 01605, USA.
Division of Infectious Disease and Immunology, University of Massachusetts Medical School, Worcester, MA, USA.
Tech Coloproctol. 2020 Sep;24(9):971-975. doi: 10.1007/s10151-020-02275-w. Epub 2020 Jun 29.
The exact pathophysiology of diverticulitis is not well understood and may be multifactorial. Recent studies highlight dysbiosis as a plausible mechanism. FMT is a safe strategy to restore commensal colon microbiota and has proven to be an effective treatment for gastrointestinal dysbiosis such as Clostridium difficile infection (CDI). There have been no studies reporting the treatment of diverticulitis with FMT. Our aim was to describe the novel application of fecal microbiota transplantation (FMT) for the treatment of recurrent diverticulitis.
We report a case of a 63-year-old woman who had a 13-year history of multiply recurrent and multifocal diverticulitis previously treated with numerous short courses of intravenous and oral antibiotics for acute flares, two segmental colon resections, and suppressive antibiotic therapy for recurrent disease. Secondary to multiple courses of antibiotics , the patient developed CDI. She was treated with a single round of FMT and subsequently stopped all antibiotics at the time of FMT.
In 20 months of follow-up, the patient has had no further recurrence of diverticulitis or CDI.
FMT could prove to be a novel therapy for refractory diverticulitis but requires further investigation.
憩室炎的确切病理生理学机制尚不清楚，可能是多因素的。最近的研究强调了肠道菌群失调是一种合理的发病机制。粪便微生物移植（FMT）是恢复共生结肠微生物群的一种安全策略，已被证明是治疗胃肠道菌群失调（如艰难梭菌感染（CDI））的有效方法。目前还没有研究报道使用 FMT 治疗憩室炎。我们的目的是描述粪便微生物移植（FMT）在治疗复发性憩室炎中的新应用。
我们报告了一例 63 岁女性的病例，她有 13 年的多发性、复发性憩室炎病史，以前曾因急性发作多次接受短程静脉和口服抗生素治疗，两次节段性结肠切除术，以及为预防疾病复发而接受抑制性抗生素治疗。由于多次使用抗生素，该患者发生了艰难梭菌感染。她接受了单次 FMT 治疗，随后在 FMT 时停止了所有抗生素治疗。
在 20 个月的随访中，患者没有再次发生憩室炎或艰难梭菌感染。
FMT 可能成为治疗难治性憩室炎的一种新疗法，但需要进一步研究。
