Celik A F, Tomlin J, Read N W
Gastrointestinal Motility Unit, University of Sheffield, UK.
Aliment Pharmacol Ther. 1995 Feb;9(1):63-8. doi: 10.1111/j.1365-2036.1995.tb00353.x.
A case study reporting the efficacy of oral vancomycin in a patient with chronic idiopathic constipation prompted this prospective trial of oral vancomycin in eight female patients (aged 21-61 years) with severe constipation resistant to the action of dietary fibre.
The trial was divided into two consecutive 14-day periods. During the first period, each patient was given ispaghula, 3.5 g twice a day, and during the subsequent period they took 250 mg vancomycin t.d.s. per os, as well as the fibre supplement. During both periods they collected stools and recorded daily bowel symptoms (stool frequency, straining, stool consistency, subjective stool volume) in a diary. At the end of each period whole gut transit time and the breath hydrogen response to a standard meal, giving oro-caecal transit time, were measured along with gastrointestinal symptoms which were assessed on visual analogue scales.
Vancomycin caused a significant improvement in stool frequency, consistency, ease of defecation and the amount of stool patients felt they produced (all P < 0.05), but objective measures of daily stool weight and whole gut or oro-caecal transit time were not significantly different. Basal breath hydrogen levels were higher after vancomycin treatment in seven out of eight patients. One patient experienced a complete remission of symptoms when she took vancomycin and remains in remission after 14 months. This patient showed no elevation in basal breath hydrogen level.
Although this study does not support the use of vancomycin for most patients with constipation, the results suggest that modification of the intraluminal flora may be of value in the treatment of the occasional case of idiopathic constipation.
一项关于口服万古霉素治疗慢性特发性便秘患者疗效的病例研究促使开展了这项针对8名患有严重便秘且对膳食纤维治疗无效的女性患者（年龄21 - 61岁）的口服万古霉素前瞻性试验。
试验分为两个连续的14天周期。在第一个周期，每位患者每天服用两次3.5克的卵叶车前草种子，在随后的周期，他们口服250毫克万古霉素，每日三次，同时服用纤维补充剂。在两个周期中，患者都收集粪便，并在日记中记录每日肠道症状（排便频率、用力排便情况、粪便稠度、主观粪便量）。在每个周期结束时，测量全肠道转运时间以及对标准餐的呼气氢反应（以得出口 - 盲肠转运时间），同时通过视觉模拟量表评估胃肠道症状。
万古霉素使排便频率、稠度、排便难易程度以及患者感觉排出的粪便量有显著改善（所有P < 0.05），但每日粪便重量以及全肠道或口 - 盲肠转运时间的客观测量结果并无显著差异。8名患者中有7名在万古霉素治疗后基础呼气氢水平升高。一名患者在服用万古霉素时症状完全缓解，14个月后仍处于缓解状态。该患者基础呼气氢水平未升高。
尽管本研究不支持将万古霉素用于大多数便秘患者，但结果表明改变肠腔内菌群可能对偶尔出现的特发性便秘病例的治疗有价值。
