Fecal bacteriotherapy

A transfer of the intestinal flora for therapeutic reasons was already in the 1950s, for the first time experimentally applied from one person to another. Attention was this form of treatment again in 2013, as in the prestigious journal The New England Journal of Medicine, an article with the headline " Duodenal infusion of donor feces for Recurrent Clostridium difficile " appeared. Were the first tests carried out by means of a retrograde inlet to the colon, as in the investigation of 2013 antegrade foreign feces were introduced via a nasogastric tube into the small intestine.

The transfer of the intestinal flora to another person for therapeutic reasons is referred to in the current literature by different terms of a. In the Anglo-Saxon literature, the term fecal microbiota transplantation is often used, which means as much as gut flora fecal transplant or fecal bacterial transplantation. Also, it is common to simply describe the procedure ( for example, duodenal infusion of donor feces as much as the introduction of donor chair in the duodenum ). In the German literature, there are terms like Fäkaltherapie, stool transplant, stool transplant, disgust therapy or fecal bacteria therapy.

We investigated the transfer of the intestinal flora in the Clostridium difficile-associated colitis. The approach is that a damaged intestinal flora relapses strongly favors because Clostridium difficile bacteria can multiply unhindered thanks to lack of competition physiological intestinal bacteria. The "biodiversity" of the chair is significantly reduced in an antibiotic -associated colitis compared to normal chair.

History

The first (retrograde ) transfer of the intestinal flora in 1958 was conducted in Denver in a patient with fulminant pseudomembranous enterocolitis with life-threatening success, but did not pursue the therapeutic approach.

The therapeutic use of inward and chair is much older. Thus, already in his 1697 published textbook Healing dirt Pharmacy describes the German physician Christian Franz Paullini (born 1643, died 1712) numerous examples of his time. But even in China, the Dong -jin dynasty in the 4th century described Ge Hong in an emergency medicine textbook already an inward faeces application ..

Implementation

When normalizing the intestinal flora of the stool of a healthy donor is mixed with physiological saline and given by an enema or via colonoscopy in the colon of the patient. The administration of the chair can also be made by a Nasoduodenalsonde ( gavage ) in the duodenum.

Clinical trials

First overviews of individual case reports showed successful treatment with applied by enema or colonoscopy chair at 92 %. A first randomized controlled non -blinded Dutch- Finnish study had to be terminated prematurely with a significant superiority of the chair transplantation. With only 42 older study patients who had suffered all one to nine relapses of Clostridium difficile enterocolitis, 16 patients received after a four-day vancomycin administration and a colon cleanse a stool transplant means nasoduodenaler probe. This therapy was in 13 patients (81%) at the first attempt successfully without relapse in the first ten weeks a second chair transplantation was successful in two of the remaining three patients. In contrast, in the two control groups were only three of thirteen patients (23 %) recurrence- free, vancomycin and colon cleansing received, and only four of thirteen ( 31%) patients who received vancomycin therapy. However, this study was not blinded and included patients with immunosuppression, ICU patients and patients who received additional antibiotics for other infections from. In this study, almost all patients immediately after the chair transplantation diarrhea (94% ), many also abdominal cramps (31%) and regurgitation (19 %). After three hours, all patients were symptom-free. In the course occurred in 19% to constipation.

In addition, this technique has been applied several times in patients with chronic inflammatory bowel disease. Another indication might be the treatment of obesity are after could be demonstrated in studies with mice that fat mice decreased after bowel transplantation of thin mice weight.

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