摘要
Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.
背景:回肠储袋肛管吻合患者中艰难梭菌感染(CDI)越来越多地见诸报道。本研究目的是评估粪菌移植(FMT)对CDI储袋患者的治疗效果。方法:从我们IRB批准的前瞻性储袋疾病数据库中选取2012-2016年间所有因CDI行FMT的病例。主要结局指标是FMT治疗后粪便检查艰难梭状芽胞杆菌(C.difficile)阴性率,次要结局指标是症状缓解情况和内镜下病变改善情况。结果:共13例患者纳入研究,其中10例(76.9%)为白人男性。所有病例均因溃疡性结肠炎行J型储袋手术。在经过平均(2.8±0.8)个疗程的抗生素治疗失败后,共施行了22次FMT治疗,平均每例患者(1.7±1.1)次。在22次治疗中,16次是通过储袋镜、4次通过食管胃十二指肠镜、2次通过灌肠进行FMT治疗。在初次FMT治疗后,所有病例C.difficile PCR检测均为阴性;58.3%(7/12)的病例症状得到缓解;根据修订储袋疾病活动指数,27.3%(3/11)的病例内镜下病变获得改善。在(1.2±1.1)年的随访期间,5例(38.5%)患者在初次FMT治疗后复发,其中4例成功接受了再次FMT治疗。结论:FMT似乎能有效治疗回肠储袋患者的CDI。然而,FMT对内镜下炎症病变的改善作用有限,且治疗后容易复发。
