Fäkaler Mikrobiom-Transfer bei therapierefraktärem Diarrhoe-betontem Reizdarmsyndrom

 

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Zusammenfassung

Das Reizdarmsyndrom (Reizdarmsyndrom) ist eine Erkrankung des Gastrointestinaltrakts mit unklarer Ätiologie. Aus mehreren Studien wissen wir, dass beim Reizdarmsyndrom unter anderem eine Veränderung der Darmflora mit einer verringerten Biodiversität vorliegt. Ob diese Veränderungen der Mikrobiota ursächlich sind oder Folge der Erkrankung sind, ist unklar.

Ein fäkaler Mikrobiom-Transfer (FMT) wird bei Patienten mit therapierefraktärer Clostridium difficile- assoziierter Diarrhoe erfolgreich eingesetzt. Kasuistisch sind auch Therapieerfolge bei Reizdarmpatienten beschrieben.

Wir berichten über einen 47-jährigen Patienten mit einem therapierefraktärem Diarrhoe-betontem Reizdarmsyndrom, bei dem mit Hilfe eines FMT eine deutliche Verbesserung der klinischen Symptomatik erreicht werden konnte. Diese war von Veränderungen der Zusammensetzung des Empfängerstuhlmikrobioms begleitet. Post-FMT ähnelte das Empfängermikrobiom dem Mikrobiom des Donorstuhls.

Abstract

Irritable bowel syndrome is a disorder of the gastrointestinal tract with unknown etiology. Recent clinical data support a link between changes in fecal microbiota with decreased biodiversity and the development of irritable bowel syndrome. Whether these changes of the microbiota are caused by the disease or whether they develop during the course of the disease remains unclear.

Several studies demonstrated that fecal microbiota transfer (FMT) successfully attenuates Clostridium difficile infection by restoring the disturbed bacterial flora of the gut and case reports suggest that FMT may relief symptoms in patients with irritable bowel syndrome (IBS).

Here we report a 47-year-old male patient with longstanding refractory diarrhea predominant IBS, who was successfully treated with a single FMT. The beneficial effect on the patient’s symptoms was associated with changes of the stool microbiome. Post-FMT the recipient’s microbiome resembled the donor´s microbiome.

• Literatur

• 1 Anderson JL, Edney RJ, Whelan K. Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease. Aliment Pharmacol Ther 2012; 36: 503-516
  CrossrefPubMedGoogle Scholar
• 2 Borody TJ, George L, Andrews PJ et al. Bowel flora alteration: a potential cure for inflammatory bowel disease and irritable bowel syndrome?. Med J Aust 1989; 150: 604
  PubMedGoogle Scholar
• 3 Borody TJ, Khoruts A. Fecal microbiota transplantation and emerging applications. Nat Rev Gastroenterol Hepatol 2011; 9: 88-96
  CrossrefPubMedGoogle Scholar
• 4 Borody TJ, Paramsothy S, Agrawal G. Fecal microbiota transplantation: indications, methods, evidence, and future directions. Curr Gastroenterol Rep 2013; 15: 337
  CrossrefPubMedGoogle Scholar
• 5 Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infec Dis 2011; 53: 99-1002
  CrossrefPubMedGoogle Scholar
• 6 Gwee K-A. Irritable bowel syndrome in developing countries – a disorder of civilization or colonization?. Neurogastroenterol Motil 2005; 17: 317-324
  CrossrefPubMedGoogle Scholar
• 7 Kassam Z, Lee CH, Yuan Y et al. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. AM J Gastroneterol 2013; 108: 500-508
  PubMedGoogle Scholar
• 8 Kassinen A, Krogius-Kurikka L, Mäkivuokko H et al. The fecal microbiota of irritable bowel syndrome patients differs significantly from that of healthy subjects. Gastroenterology 2007; 133: 24
  CrossrefPubMedGoogle Scholar
• 9 Khoruts A, Dicksved J, Jansson JK, Sadowsky MJ. Changes in the composition of the human fecal microbiome after bacteriotherapy for recurrent Clostridium difficile-associated diarrhea. J Clin Gastroenterol 2010; 44: 354-360
  PubMedGoogle Scholar
• 10 King TS, Elia M, Hunter JO. Abnormal colonic fermentation in irritable bowel syndrome. Lancet  1998; 352: 1187-1189
  CrossrefPubMedGoogle Scholar
• 11 Kump PK et al. Empfehlung zur Anwendung der fäkalen Mikrobiotatransplantation „Stuhltransplantation“: Konsensus der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) in Zusammenarbeit mit der Österreichischen Gesellschaft für Infektiologie und Tropenmedizin (OEGIT). Z Gastroenterol 2014; 52: 1485-1492
  Article in Thieme ConnectPubMedGoogle Scholar
• 12 Landy J, Al-Hassi HO, McLaughlin SD et al. Review article: faecal transplantation therapy for gastrointestinal disease. Aliment Pharmacol Ther 2011; 34: 409-415
  CrossrefPubMedGoogle Scholar
• 13 Longstreth GF, Thompson WG, Chey WD et al. Functional bowel disorders. Gastroenterology 2006; 130: 1480
  Google Scholar
• 14 Mellon AF, Deshpande SA, Mathers JC, Bartlett K. Effect of oral antibiotics on intestinal production of propionic acid. Arch Dis Child 2000; 82: 169-172
  CrossrefPubMedGoogle Scholar
• 15 Ott SJ, Musfeldt M, Wenderoth DF et al. Reduction in diversity of the colonic mucosa associated bacterial microflora in patients with active inflammatory bowel disease. Gut 2004; 53: 685-693
  CrossrefPubMedGoogle Scholar
• 16 Saito YA, Schoenfeld P, Locke GRI. The epidemiology of irritable bowel syndrome in North America: a systemic review. Am J Gastroenterol 2002; 97: 1910-1915
  PubMedGoogle Scholar
• 17 Sartor RB. Microbial influences in inflammatory bowel diseases. Gastroenterology 2008; 134: 577-594
  CrossrefPubMedGoogle Scholar
• 18 Seksik P, Rigottier-Gois L, Gramet G et al. Alterations of the dominant faecal bacterial groups in patients with Crohn’s disease of the colon. Gut 2003; 52: 237-242
  CrossrefPubMedGoogle Scholar
• 19 Si JM, Yu YC, Fan YJ, Chen SJ. Intestinal microecology and quality of life in irritable bowel syndrome patients. World J Gastroenterol 2004; 10: 1802-1805
  CrossrefPubMedGoogle Scholar
• 20 Simrén M, Barbara G, Flint HJ et al. Intestinal microbiota in functional bowel disorders: a Rome foundation report. Gut 2013; 62: 159-176
  CrossrefPubMedGoogle Scholar
• 21 Surawicz CM. Probiotics, antibiotic-associated diarrhoea and Clostridium difficile diarrhoea in humans. Best Pract Res Clin Gastroenterol 2003; 17: 775-783
  CrossrefPubMedGoogle Scholar
• 22 Fecal transplant at home – DIY Instructions. http://thepowerofpoop.com/epatients/fecal-transplant-instructions Letzter Zugriff: 31.7.2015
  Google Scholar
• 23 van Nood E, Vrieze A, Nieuwdorp M et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013; 368: 407-415
  CrossrefPubMedGoogle Scholar
• 24 Vrieze A, Van Nood E, Holleman F et al. Transfer of intestinal microbiota from & lean donors increases insulin sensitivity in individuals with metabolic syndrome. Gastroenterology 2012; 143: 913-916
  CrossrefPubMedGoogle Scholar
• 25 Watanabe S, Narisawa Y, Arase S et al. Differences in fecal microflora between patients with atopic dermatitis and healthy control subjects. J Allergy Clin Immunol 2003; 111: 587-591
  CrossrefPubMedGoogle Scholar
• 26 Wilson A, Longstreth G, Knight K et al. Quality of life in managed care patients with irritable bowel syndrome. Manag Care Interface 2004; 17: 24-28
  PubMedGoogle Scholar
• 27 Zhang F, Luo W, Shi Y et al. Should we standardize the 1, 700-year-old fecal microbiota transplantation?. Am J Gastroenterol 2012; 107: 1755; author reply 1755-1756
  PubMedGoogle Scholar