克羅恩氏病

什麼是克羅恩氏病？

克羅恩氏病是一種慢性，複發性腸道炎。克羅恩氏病主要在兩個部位病發，分別是迴腸和結腸。迴腸是小腸的最後部分（迴腸炎，區域性腸炎）；結腸（克羅恩氏結腸炎）。病情初期出現一窩窩巢狀微細的發炎症狀，發炎情況會持續並且擴大範圍。腸道內黏膜會導致潰瘍而令腸壁變厚。最終，會因腸會變窄或阻塞，而需要手術。

怎麼診斷？

病人的病歷和身體檢查對斷症很有幫助。血液和糞便儉驗更能準確地斷症。為小腸和結腸照X光也有助斷症 （包括上消化道並與灌腸劑配合使用）。此外，有需要時，會使用乙狀結腸鏡檢查直腸和下消化道的黏膜。結腸鏡檢查，更能徹底地檢查一整條結腸， 是最有效的診斷腸道疾病的方法。

為什麼人類菌群移植療法（HMT）與克羅恩病的症狀有關？

炎症性腸病（IBD）患者的腸道菌群會有一連串的變化。當腸道菌群達到最高水平，這樣會使腸道菌群多樣性下降，變成失衡狀態（稱為菌群失調dysbiosis）。HMT已被研究証實可抑制克羅恩病的症狀。在最近的一項統計分析中顯示出，82位患者中有42 位 （50.5%）接受人類菌群移植療法之後，症狀獲得臨床上的緩和，並沒有明顯的副作用1。

什麼是香港HMT計劃 ?

亞洲益菌中心與本地知名胃腸病專家緊密合作。我們的HMT治療程序是由我們的腸胃科專家顧問的建議及因個人需要而訂立出來。
該計劃是通過恢復腸道內微生物菌群的平衡，來幫助您緩解不適的症狀，由此獲得長期益處。

計劃概要:

• 患者會安排在2-3週內接受連續五天HMT療程，或是兩次的五天HMT療程（總共10天）。
• HMT可通過灌腸，口服膠囊或結腸鏡（需要額外費用）下值入到腸道內。
• 在接受HMT治療之前，個體將經歷由標準的腸道準備或結腸水灌洗組成的腸道準備。

病人須知

人類菌群移植療法（HMT）主要目的是重新平衡患者腸道中的微生物群，這可以舒緩患者腸道的相關症狀。潰瘍性結腸炎是一種醫學疾病，治療必須要在醫生的監督下進行。如有任何有關藥物上或處方上的問題請諮詢你家庭醫生。因此，患者在接受治療之前，必須要獲得醫生簽發的轉介信。

Further diagnosis details

Your doctor may ask to have further blood tests to test if you are anaemic and whether your illness has caused the level of protein to fall. In general, the greater the degree of anaemia and the lower the protein level, the more severe the inflammation is likely to be. Doctors also use special blood tests called ESR and CRP to give a measure of the degree of inflammation. You may be asked to give small samples of your bowel motions, to measure levels of faecal calprotectin, which is a marker of inflammation and to be sure there are no signs of any bowel infection.

Further microbiota details

In CD patients gut microbiome shifts, often these shifts include fewer bacteria in the Bacteroides and Lachnospiraceae groups (phyla), but more in the Proteobacteria and Actinobacteria groups (phyla). In addition, a decrease in a butyrate-producing bacterium, which is important in intestinal health, has been observed in patients with IBD. Therefore, researches around the world are exploring the efficacy and safety of FMT for CD patients including those patients who are unresponsive to current conventional therapy, such as anti-inflammatory agents, steroids, immune-suppressives, and biological therapies2.

Article Abstract 1:

Faecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.
J Crohns Colitis. 2017 May 9. doi: 10.1093/ecco-jcc/jjx063. [Epub ahead of print]

Faecal microbiota transplantation (FMT) has been investigated as a potential treatment for inflammatory bowel disease (IBD). We thus performed a systematic review and meta-analysis assessing the effectiveness and safety of FMT in IBD. A systematic review was conducted until Jan 2017. Studies were excluded if patients had co-infection or data was pooled across disease subtypes (ulcerative colitis (UC), Crohn’s disease (CD), pouchitis). Clinical remission was established as the primary outcome. Pooled effect sizes and 95% confidence intervals were obtained using the random effects model.  53 studies were included (41 in UC, 11 in CD, 4 in pouchitis). Overall, 36% (201/555) of UC, 50.5% (42/83) of CD and 21.5% (5/23) of pouchitis patients achieved clinical remission.