Arbabzada Naik, Dennett Liz, Meng Guanmin, Peerani Farhad
Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, AB, Canada.
Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Edmonton, AB, Canada.
Inflamm Bowel Dis. 2025 Jul 7;31(7):2027-2035. doi: 10.1093/ibd/izae257.
Approximately 70% of primary sclerosing cholangitis (PSC) patients have inflammatory bowel disease (IBD). The IBD therapies currently used to treat PSC-IBD patients have side effects and can be costly. Oral vancomycin (OV)-a safe, economical, and convenient therapy-has been reported to be a salvage therapy in refractory PSC-IBD patients. This systematic review aims to summarize the current literature regarding the effectiveness and safety of OV to treat IBD in PSC patients.
A systematic literature review of Scopus, Embase, Web of Science, MEDLINE, and CINAHL was performed until March 2024. The Murad scale, Newcastle-Ottawa scale, and Cochrane Collaboration Risk of Bias Tool were used to determine the quality of the case reports and case series, cohort studies, and randomized controlled trial (RCT), respectively. The outcomes sought were response or remission across clinical, biochemical, endoscopic, and histological parameters.
Of the 1725 published studies, we identified 9 case reports, 7 case series, 3 cohort studies, and 1 RCT. Most studies reported an improvement in clinical IBD symptoms such as diarrhea and hematochezia. Fewer publications provided supporting objective data in the form of fecal calprotectin, endoscopic Mayo scores, and histology. There were no reports of vancomycin-resistant enterococci infections.
Oral vancomycin appears safe and effective to treat IBD in a subset of PSC patients. Future studies would benefit from prospective data collection incorporating standardized symptomatic, endoscopic, and histologic indices. Ultimately, a well-powered RCT is needed to better assess the effectiveness, safety, and durability of OV therapy.
约70%的原发性硬化性胆管炎（PSC）患者患有炎症性肠病（IBD）。目前用于治疗PSC-IBD患者的IBD疗法有副作用且成本高昂。口服万古霉素（OV）——一种安全、经济且便捷的疗法——已被报道为难治性PSC-IBD患者的挽救疗法。本系统评价旨在总结当前关于OV治疗PSC患者IBD有效性和安全性的文献。
对Scopus、Embase、Web of Science、MEDLINE和CINAHL进行系统文献回顾，截至2024年3月。分别使用Murad量表、纽卡斯尔-渥太华量表和Cochrane协作偏倚风险工具来确定病例报告和病例系列、队列研究以及随机对照试验（RCT）的质量。所寻求的结果是临床、生化、内镜和组织学参数方面的反应或缓解。
在1725项已发表的研究中，我们确定了9篇病例报告、7个病例系列、3项队列研究和1项RCT。大多数研究报告IBD临床症状如腹泻和便血有所改善。较少的出版物以粪便钙卫蛋白、内镜梅奥评分和组织学的形式提供支持性客观数据。没有关于耐万古霉素肠球菌感染的报告。
口服万古霉素在一部分PSC患者中治疗IBD似乎安全有效。未来的研究将受益于纳入标准化症状、内镜和组织学指标的前瞻性数据收集。最终，需要一项有力的RCT来更好地评估OV疗法的有效性、安全性和持久性。
