利福昔明联合肠菌移植治疗腹泻型肠易激综合征的临床疗效及安全性
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摘要
目的:评价利福昔明联合肠菌移植治疗腹泻型肠易激综合征的疗效及安全性。方法:选择合适的腹泻型肠易激综合征患者,给予利福昔明与肠菌移植联合治疗。随访6个月,观察治疗前后患者腹部不适及排便异常有无改善,同时行心理学评价,并收集肠菌标本进行测序。结果:共入组7例患者,总治疗次数11次。联合治疗对腹泻症状改善效果显著,总体有效率71.4%,显效高峰在2周～1个月,不超过3个月;患者伴发的焦虑或抑郁情绪改善。不良反应以短期腹泻最多见。所有经治者肠道微生态均发生改变,而后随时间推移向基线回归。供菌者的肠菌组成与疗效及肠菌移植治疗的不良反应密切相关。结论:联合治疗有一定疗效且较为安全,并能影响经治者的肠道微生态,但维持时间短,病情易复发。
Objective: To evaluate the efficacy and safety of rifaximin combined with fecal microbiota transplantation in the treatment of irritable bowel syndrome(IBS) with predominant diarrhea. Methods: The qualified IBS patients with predominant diarrhea were selected and treated with rifaximin combined with fecal microbiota transplantation. The patients were followed up for 6 months. The abdominal discomfort and defecation patterns were observed before and after the treatment. At the same time, the mental state was evaluated. The fecal microbiota of patients and donors was collected and thoroughly sequenced. Results: A total of 7 patients were enrolled and treated for 11 times. The therapy was especially good for reducing the defecation with an overall effective rate of 71.4%. The peak of effect was between 2 weeks and 1 month, and the effect lasted no more than 3 months. The anxiety and depression status in certain patients were improved. Short-time diarrhea after the treatment was the most common adverse effect. The intestinal microecology of all the treated patients changed and regressed to baseline. The microbiota composition of donors was associated with the therapy effect and adverse effects. Conclusions: The combined therapy is effective and safe, and could affect the intestinal microecology of the treated patients, while the maintenance time is short and the original disease is easy to relapse.
Objective: To evaluate the efficacy and safety of rifaximin combined with fecal microbiota transplantation in the treatment of irritable bowel syndrome(IBS) with predominant diarrhea. Methods: The qualified IBS patients with predominant diarrhea were selected and treated with rifaximin combined with fecal microbiota transplantation. The patients were followed up for 6 months. The abdominal discomfort and defecation patterns were observed before and after the treatment. At the same time, the mental state was evaluated. The fecal microbiota of patients and donors was collected and thoroughly sequenced. Results: A total of 7 patients were enrolled and treated for 11 times. The therapy was especially good for reducing the defecation with an overall effective rate of 71.4%. The peak of effect was between 2 weeks and 1 month, and the effect lasted no more than 3 months. The anxiety and depression status in certain patients were improved. Short-time diarrhea after the treatment was the most common adverse effect. The intestinal microecology of all the treated patients changed and regressed to baseline. The microbiota composition of donors was associated with the therapy effect and adverse effects. Conclusions: The combined therapy is effective and safe, and could affect the intestinal microecology of the treated patients, while the maintenance time is short and the original disease is easy to relapse.
引文
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[15] BUCKLEY M M,O’MAHONY S M,O'MALLEY D.Convergence of neuro-endocrine-immune pathways in the pathophysiology of irritable bowel syndrome[J].World J Gastroenterol,2014,20(27):8846-8858.
[16] B?CKHED F,FRASER C M,RINGEL Y,et al.Defining a healthy human gut microbiome:current concepts,future directions,and clinical applications[J].Cell Host Microbe,2012,12(5):611-622.
[2] DISTRUTTI E,MONALDI L,RICCI P,et al.Gut microbiota role in irritable bowel syndrome:New therapeutic strategies[J].World J Gastroenterol,2016,22(7):2219-2241.
[3] K?NIG J,BRUMMER R J.Alteration of the intestinal microbiota as a cause of and a potential therapeutic option in irritable bowel syndrome[J].Benef Microbes,2014,5(3):247-261.
[4] MENEES S B,MANEERATTANNAPORN M,KIM H M,et al.The efficacy and safety of rifaximin for the irritable bowel syndrome:a systematic review and meta-analysis[J].Am J Gastroenterol,2012,107(1):28-35.
[5] HOLVOET T,BOELENS J,JOOSSENS M,et al.Tu2025 Fecal microbiota transplantation in irritable bowel syndrome with bloating:results from a prospective pilot study[J].Gastroenterology,2015,148(4):S963-S964.
[6] AGUILAR R C,BUCH T,BAJBOUJ M,et al.Fecal microbiota transplantation as a novel therapy for irritable bowel syndrome with predominant diarrhea[J].neurogastroenterology and motility,2015,272(si):110.
[7] PIMENTEL M,LEMBO A,CHEY W D,et al.Rifaximin therapy for patients with irritable bowel syndrome without constipation[J].N Engl J Med,2011,364(1):22-32.
[8] SHARMA P,SHARMA B C.Rifaximin treatment in hepatic encephalopathy[J].N Engl J Med,2010,362(25):2423-2425.
[9] KELLY C R,KAHN S,KASHYAP P,et al.Update on fecal microbiota transplantation 2015:indications,methodologies,mechanisms,and outlook[J].Gastroenterology,2015,149(1):223-237.
[10] BRANDT L J,ARONIADIS O C.An overview of fecal microbiota transplantation:techniques,indications,and outcomes[J].Gastrointest Endosc,2013,78(2):240-249.
[11] FOND G,LOUNDOU A,HAMDANI N,et al.Anxiety and depression comorbidities in irritable bowel syndrome (IBS):a systematic review and meta-analysis[J].Eur Arch Psychiatry Clin Neurosci,2014,264(8):651-660.
[12] FORSYTHE P,KUNZE W A.Voices from within:gut microbes and the CNS[J].Cell Mol Life Sci,2013,70(1):55-69.
[13] ROSSEN N G,MACDONALD J K,DE VRIES E M,et al.Fecal microbiota transplantation as novel therapy in gastroenterology:A systematic review[J].World J Gastroenterol,2015,21(17):5359-5371.
[14] KASHYAP P C,MARCOBAL A,URSELL L K,et al.Complex interactions among diet,gastrointestinal transit,and gut microbiota in humanized mice[J].Gastroenterology,2013,144(5):967-977.
[15] BUCKLEY M M,O’MAHONY S M,O'MALLEY D.Convergence of neuro-endocrine-immune pathways in the pathophysiology of irritable bowel syndrome[J].World J Gastroenterol,2014,20(27):8846-8858.
[16] B?CKHED F,FRASER C M,RINGEL Y,et al.Defining a healthy human gut microbiome:current concepts,future directions,and clinical applications[J].Cell Host Microbe,2012,12(5):611-622.