感染后肠易激综合征患者肠黏膜炎性细胞因子的失衡

目的通过检测感染后肠易激综合征(pIBS)患者肠黏膜炎性细胞因子白细胞介素(IL)-6、IL-18和IL-13的表达,探讨Th1及Th2淋巴细胞在感染后肠易激综合征发病中的作用和机制。方法随机抽取肠易激综合征(IBS)患者50例,其中感染后肠易激综合征患者23例,非感染后肠易激综合征(non-pIBS)患者27例,另设结肠息肉电切术后复查者20例为对照组,应用免疫组化方法分别检测肠易激综合征患者和对照组回盲部、直肠黏膜IL-6、IL-18、IL-13的表达。结果感染后IBS患者IL-6、IL-18的黏膜表达阳性率高于对照组(P0.05)及非感染后IBS组(P0.05);非感染后IBS患者IL-6、IL-18的黏膜表达阳性率与对照组比较无显著差异(P0.05);IL-13在感染后IBS及非感染后IBS患者回盲部及直肠的阳性表达率与对照组比较无明显差异(P0.05)。结论感染后肠易激综合征患者以Th1反应为主,促炎细胞因子可能诱发Th1/Th2的平衡失调。     

肠易激综合征患者乙状结肠粘膜内5—羟色胺含量的临床研究

我们选取了19例肠易激综合征患者,对照组8名肠癌病人,检测其乙状结肠粘膜内5—羟色胺(5—HT)含量,发现肠易激综合征患者的5—HT浓度显著低于对照组(P<0.05)。并讨论了乙状结肠粘膜内5—HT含量的降低与肠易激综合征(IBS)患者肠内压升高、慢波活动增多的病理改变之间的关系。讨论了5—HT的改变与肠易激综合征患者的精神症状之间可能存在的联系。     

得舒特治疗肠易激综合征的临床疗效观察

目的:评价得舒特对肠易激综合征(IBS)的疗效。方法:56例根据罗马标准诊断为IBS的患者进入本研究。所有患者在服用得舒特治疗前一周服用安慰剂6天。安慰剂治疗无效的47例患者随后进入得舒特治疗,50mg,每日3次口服,疗程4周。结果:得舒特对肠易激综合征患者腹痛、腹泻和便秘单项症状的有效率分别为85.1％(40/47)、89.2％(33/37)和93.3％(14/15),对肠易激综合征的总有效率为85.1％(40/47)。治疗期间除2例诉头晕外,无其他不良反应。结论:得舒特治疗1BS疗效确切、副反应率低,临床上可作为治疗IBS的首选药物之一。     

体表肠电图对肠易激综合征的诊断价值

肠易激综合征(Irritable bowel syndrome,IBS)是最常见的消化系统疾病之一,被认为是肠功能紊乱性疾病。本文应用EGEG-VD型微机处理系统对正常人20名,IBS患者56例测定体表肠电图,旨在探讨IBS患者体表肠电图是否有其特殊性改变,判定体表肠电图对IBS的诊断价值。     

替加色罗对肠易激综合征患者血浆内皮素、胃动素的影响

肠易激综合征(IBS)是临床上最常见的功能性胃肠病之一。2003年10月至2004年5月我们应用替加色罗治疗肠易激综合征患者50例，观察其血浆内皮素(ET)、胃动素(MTL)含量的变化，旨在探讨其治疗IBS的有效性。     

粪便钙卫蛋白在IBS与IBD鉴别诊断中的意义

目的:研究粪钙卫蛋白在炎症性肠病(inflammatory bowel disease,IBD)与肠易激综合征(irritable bowel syndrome,IBS)鉴别诊断中的意义.方法:收集中国人民解放军北京军区总医院消化内镜中心接受肠镜检查患者的新鲜粪便标本共92例,其中溃疡性结肠炎(UC)23例、克罗恩病(CD)4例、IBS 55例、健康人20例.采用ELISA法半定量检测粪便中钙卫蛋白浓度.结果:健康人粪钙卫蛋白浓度为77.15±160.9μg/g,IBS患者为46.08±131.97 μg/g,IBD患者为851.34±522.19 μg/g.IBS患者和健康人粪钙卫蛋白浓度差异无显著差异(P>0.05); IBD与IBS和健康人粪钙卫蛋白水平有显著差异(P<0.001).以60 μg/g为临界值时鉴别IBD与IBS的敏感性86.7%,特异性为96.3%.结论:粪便钙卫蛋白含量检测作为一种非侵入性筛选试验,为临床鉴别IBD和IBS提供了手段.     

对肠易激综合征诊断标准的解读

肠易激综合征(irritable bowel syndrome,IBS)是一种常见的功能性肠病,2006年修订出版的<功能性胃肠病:罗马Ⅲ>对IBS的诊断标准和分型作了一些修订[1].     

肠易激综合征感觉异常研究进展

肠易激综合征(IBS)是以腹痛和/或腹部不适伴排便异常为特征性症状的一组肠功能障碍性综合征,近年来的研究表明患者结肠对机械、化学、温度、电刺激等感觉过敏,可能是IBS最重要的致病因素之一.此文综述近年来有关肠易激综合征患者肠神经系统、脊髓及中枢神经系统存在结构或功能的异常.     

聚克胶囊配合舒丽启能治疗腹泻型肠易激综合征临床疗效分析

肠易激综合征（IBS）是一种常见的慢性非器质性肠功能紊乱疾病,门诊患者中以腹泻型肠易激综合征（D—IBS）较多见。我院门诊应用肠道活菌制剂聚克胶囊配合舒丽启能治疗D—IBS取得较好的临床疗效。现将结果报道如下。     

副伤寒感染后肠易激综合征发病情况的临床分析

目的观察和分析副伤寒感染后肠易激综合征的发病情况。方法调查2010年1月-2012年11月在我院接受治疗并出院的副伤寒感染患者101例为研究对象,记该组选取对象为观察组;同时选取同期100例健康人为对照组,分析观察组患者在副伤寒感染痊愈后3个月、6个月、12个月内发生肠功能紊乱以及肠易激综合征(IBS)情况,并对IBS症状患者给予相关检查。结果观察组101例患者副伤寒感染痊愈后发生IBS的几率明显高于对照组,且副伤寒感染病程时间越长,发生IBS几率越高,两组患者在IBS发生率对比差异有统计学意义(P0.05)。结论患者在副伤寒感染后,较易发生IBS,而肠道感染与IBS之间存在相关,通过有效治疗,快速控制症状,对于降低IBS发生率有着积极的意义。     

Clinical response to fecal microbiota transplantation in patients with diarrhea-predominant irritable bowel syndrome is associated with normalization of fecal microbiota composition and short-chain fatty acid levels

Objectives: Irritable bowel syndrome (IBS) may be associated with disturbances in gut microbiota composition and functions. We recently performed a study of fecal microbiota transplantation (FMT) in diarrhea-predominant IBS (IBS-D) and found that IBS symptoms improved and the gut microbiota profile changed following FMT. We now aimed to explore the effects of FMT on the gut microenvironment in further detail by using 16S rRNA sequencing for more extended microbiota profiling and analyzing bacterial fermentation products (SCFAs: short chain fatty acids).

Materials and methods: The study included 13 patients (four females and nine males) with IBS-D according to Rome III criteria and 13 healthy donors. Freshly donated feces were administered into duodenum via gastroscopy. The patients completed symptom and quality of life (QoL) questionnaires and delivered feces before and 1, 3, 12 and 20/28 weeks after FMT. Microbiota analysis was performed by sequencing 16S rRNA gene with Illumina Miseq technology. Fecal concentrations of SCFAs were analyzed by vacuum distillation followed by gas chromatography.

Results: Several gut microbiota taxa and SCFAs were significantly different in the patients at baseline compared to their donors. These differences normalized by the third week following FMT in parallel with significant improvement in symptoms and QoL. Responders had different gut microbiota profile and SCFAs than nonresponders. Significant correlations were found between the gut microenvironment and IBS symptoms. No adverse effects were reported.

Conclusions: FMT restores alterations of the gut microenvironment in IBS-D patients during the first 3 weeks and improves their symptoms for up to 28 weeks.

ClinicalTrials.gov ID: NCT03333291.     

Fecal microbiota transplantation for irritable bowel syndrome: An intervention for the 21st century

Irritable bowel syndrome (IBS) affects about 12% of the global population. Although IBS does not develop into a serious disease or increase mortality, it results in a considerable reduction in the quality of life. The etiology of IBS is not known, but the intestinal microbiota appears to play a pivotal role in its pathophysiology. There is no effective treatment for IBS, and so the applied treatments clinically focus on symptom relief. Fecal microbiota transplantation (FMT), an old Chinese treatment, has been applied to IBS patients in seven randomized controlled trials (RCTs). Positive effects on IBS symptoms in various degrees were obtained in four of these RCTs, while there was no effect in the remaining three. Across the seven RCTs there were marked differences in the selection processes for the donor and treated patients, the transplant dose, the route of administration, and the methods used to measure how the patients responded to FMT. The present frontier discusses these differences and proposes: (1) criteria for selecting an effective donor (superdonor); (2) selection criteria for patients that are suitable for FMT; (3) the optimal FMT dose; and (4) the route of transplant administration. FMT appears to be safe, with only mild, self-limiting side effects of abdominal pain, cramping, tenderness, diarrhea, and constipation. Although it is early to speculate about the mechanisms underlying the effects of FMT, the available data suggest that changes in the intestinal bacteria accompanied by changes in fermentation patterns and fermentation products (specifically short-chain fatty acids) play an important role in improving the IBS symptoms seen after FMT. FMT appears to be a promising treatment for IBS, but further studies are needed before it can be applied in everyday clinical practice.     

Fecal microbiota transplantation as novel therapy in gastroenterology:A systematic review

AIM:To study the clinical efficacy and safety of Fecal microbiota transplantation(FMT).We systematically reviewed FMT used as clinical therapy.METHODS:We searched MEDLINE,EMBASE,the Cochrane Library and Conference proceedings from inception to July,2013.Treatment effect of FMT was calculated as the percentage of patients who achieved clinical improvement per patient category,on an intention-to-treat basis.RESULTS:We included 45 studies;34 on Clostridium difficile-infection(CDI),7 on inflammatory bowel disease,1 on metabolic syndrome,1 on constipation,1 on pouchitis and 1 on irritable bowel syndrome(IBS).In CDI 90% resolution of diarrhea in 33 case series(n = 867) was reported,and 94% resolution of diarrhea after repeated FMT in a randomized controlled trial(RCT)(n = 16).In ulcerative colitis(UC) remission rates of 0% to 68% were found(n = 106).In Crohn's disease(CD)(n = 6),no benefit was observed.In IBS,70% improvement of symptoms was found(n = 13).100% Reversal of symptoms was observed in constipation(n = 3).In pouchitis,none of the patients(n = 8) achieved remission.One RCT showed significant improvement of insulin sensitivity in metabolic syndrome(n = 10).Serious adverse events were rare.CONCLUSION:FMT is highly effective in CDI,and holds promise in UC.As for CD,chronic constipation,pouchitis and IBS data are too limited to draw conclusions.FMT increases insulin sensitivity in metabolic syndrome.     

Clinical results and microbiota changes after faecal microbiota transplantation for chronic pouchitis: a pilot study

Abstract

Objectives: Research evidence suggests that chronic pouchitis is associated with intestinal dysbiosis. Faecal microbiota transplantation (FMT) has been proposed as a possible treatment. We performed a 6-month prospective, open-label, single-centre cohort pilot-study (NCT03538366) to investigate if FMT could improve clinical outcome and alter gut microbiota in patients with chronic pouchitis.

Materials and methods: Nine adult patients with chronic pouchitis were included and allocated to 14?days FMT by enemas from five faecal donors, with a 6-month follow-up. Pouchitis severity was assessed using pouchitis disease activity index (PDAI) before and after FMT. Changes in gut microbiota, and engraftment of donor’s microbiota were assessed in faecal samples.

Results: All patients were treated with FMT for 14 continuous days. Overall, four of nine patients receiving FMT were in clinical remission at 30-day follow-up, and three patients remained in remission until 6-month follow-up. Clinical symptoms of pouchitis improved significantly between inclusion and 14-day follow-up (p?=?.02), but there was no improvement in PDAI between inclusion (mean 8.6) and 30-day follow-up (mean 5.2). Treatment with FMT caused a substantial shift in microbiota and increased microbial diversity in six patients, resembling that of the donors, with a high engraftment of specific donor microbiota.

Conclusions: Symptomatic benefit in FMT treatment was found for four of nine patients with chronic pouchitis with increased microbial diversity and high engraftment of donor’s microbiota. A larger, randomised controlled study is required to fully evaluate the potential role of FMT in treating chronic pouchitis.     

Can fecal microbiota transplantation cure irritable bowel syndrome?

AIM To verify the utility of treatment with fecal microbiota transplantation(FMT) in patients with irritable bowel syndrome(IBS).METHODS We searched EMBASE, Cochrane Library and Pub Med in March, 2017. The reviewed literature was based on two systematic searches in each of the databases. The Me SH terms used were IBS and fecal microbiota transplantation and the abbreviations IBS and FMT. Reference lists from the articles were reviewed to identify additional pertinent articles. RESULTS A total of six conference abstracts, one case report, one letter to the editor, and one clinical review were included. In the final analysis, treatment of 48 patients was evaluated. Treatment revealed an improvement in 58% of cases. The varying structure of the nine included studies must be taken into consideration.CONCLUSION Data on FMT and IBS are too limited to draw sufficientconclusions. Standardized double blinded randomized clinical trials need to be carried out to evaluate the effect of FMT on IBS.     

Fecal microbiota transplantation against irritable bowel syndrome? Rigorous randomized clinical trials are required

Halkj?r et al searched systematically nine articles including 48 patients, and concluded that fecal microbiota transplantation(FMT) can be an ideal treatment option for irritable bowel syndrome(IBS) subjects. Regardless of the few successes in current traditional therapies(change in diet, herbal medicine and antibiotics) in IBS, a sharp increase in interests in the FMT option has been reported in the current century. However, there is a long list of unclear issues concerning the application of FMT for the treatment of IBS. Route of delivery and optimum dosage are the major concerns to consider before using in clinical practice.     

Effects of fecal microbiota transplantation in subjects with irritable bowel syndrome are mirrored by changes in gut microbiome

ABSTRACT

Irritable bowel syndrome (IBS) is a common disorder of the lower gastrointestinal tract. The pathophysiology is far from settled, but a gut microbial dysbiosis is hypothesized to be a contributing factor. We earlier published a randomized double-blind placebo-controlled clinical trial on fecal microbiota transplantation (FMT) for IBS – the REFIT trial. The present data set describes the engraftment and includes participants from the study who received active FMT; 14 participants with effect of FMT (Effect) and 8 without (No effect). Samples were collected at baseline, after 6 and 12 months. Samples from the transplants (Donor) served as a comparator. In total 66 recipient samples and 17 donor samples were subjected to deep metagenomic sequencing, and taxonomic and functional analyses were performed. Alpha diversity measures showed a significantly increased diversity and evenness in the IBS groups compared to the donors. Taxonomic profiles showed higher relative abundance of phylum Firmicutes, and lower relative abundance of phylum Bacteroidetes, compared to donors at baseline. This profile was shifted toward the donor profile following FMT. Imputed growth rates showed that the resulting growth pattern was a conglomerate of donor and recipient activity. Thirty-four functional subclasses showed distinct differences between baseline samples and donors, most of which were shifted toward a donor-like profile after FMT. All of these changes were less pronounced in the No effect group. We conclude that FMT induces long-term changes in gut microbiota, and these changes mirror the clinical effect of the treatment. The study was registered in ClinicalTrials.gov (NCT02154867).     

Limited engraftment of donor microbiome via one-time fecal microbial transplantation in treated HIV-infected individuals

Many HIV-infected individuals on antiretroviral therapy (ART) exhibit persistent systemic inflammation, which predicts morbidity and mortality. ART-treated subjects concurrently exhibit marked compositional alterations in the gut bacterial microbiota and the degree of dysbiosis correlates with systemic inflammation. Whether interventions to modulate the microbiome can affect systemic inflammation is unknown. An open-label fecal microbial transplantation (FMT) was delivered by colonoscopy to asymptomatic HIV-infected ART-suppressed individuals without antibiotic pre-treatment. Stool was assessed before and after FMT for engraftment of donor microbes, and peripheral blood was assayed for immune activation biomarkers. Six participants received FMT and 2 participants served as controls. No serious adverse effects occurred during 24 weeks of follow-up. At baseline, HIV-infected individuals exhibited microbiota profiles distinct from uninfected donors. During the 8 weeks post-FMT, recipients demonstrated partial engraftment of the donor microbiome (P < 0.05). Recipient microbiota remained significantly distant from donors, unlike that observed following FMT for treatment of C. difficile infection. Systemic inflammatory markers showed no significant change post-FMT. FMT was well-tolerated in ART-treated, HIV-infected individuals. Engraftment was detectable but modest, and appeared to be limited to specific bacterial taxa. Whether antibiotic conditioning can enhance engraftment and the capacity of microbiota to modulate inflammation remains to be investigated.     

Fecal microbiota transplantation and emerging applications

Fecal microbiota transplantation (FMT) has been utilized sporadically for over 50 years. In the past few years, Clostridium difficile infection (CDI) epidemics in the USA and Europe have resulted in the increased use of FMT, given its high efficacy in eradicating CDI and associated symptoms. As more patients request treatment and more clinics incorporate FMT into their treatment repertoire, reports of applications outside of CDI are emerging, paving the way for the use of FMT in several idiopathic conditions. Interest in this therapy has largely been driven by new research into the gut microbiota, which is now beginning to be appreciated as a microbial human organ with important roles in immunity and energy metabolism. This new paradigm raises the possibility that many diseases result, at least partially, from microbiota-related dysfunction. This understanding invites the investigation of FMT for several disorders, including IBD, IBS, the metabolic syndrome, neurodevelopmental disorders, autoimmune diseases and allergic diseases, among others. The field of microbiota-related disorders is currently in its infancy; it certainly is an exciting time in the burgeoning science of FMT and we expect to see new and previously unexpected applications in the near future. Well-designed and well-executed randomized trials are now needed to further define these microbiota-related conditions.