什麼是潰瘍性大腸炎 Ulcerative Colitis(UC)?

發炎性腸病Inflammatory Bowel Disease(IBD)可分為兩種,潰瘍性大腸炎 Ulcerative colitis 和 克隆氏症Crohn’s disease(CD)。UC患者的腸道腸壁表面上會形成微小的潰瘍,這些潰瘍可能會在腸道內出血或流膿。患病初期,通常於直腸和下結腸發炎,但炎症可能會影響整條結腸。UC患者的整條大腸(直腸至結腸)內腸壁都會發炎及形成潰瘍。而炎症是當身體面對受創傷或刺激的反應,並可導致發紅,腫脹和疼痛。

如何診斷?

如果患者患有肚瀉而糞便中帶血及腹部疼痛,醫生便會初步診斷為潰瘍性大腸炎,為確定診斷患者將被要求進行血液檢查。而且需要時患者將會進行大腸鏡檢查及活組織化驗來確診。

為什麼選擇人類菌群移植療法 Human Microbiota Transplant(HMT)來舒緩 潰瘍性大腸炎Ulcerative Colitis (UC) 有關的症狀?

發炎性腸病(IBD)患者的腸道菌群會有持續性的變化。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治療UC已經在一些研中產生了正面的結果。在一份的研究報告中,555名UC患者中有201位(約36%)接受HMT治療後獲得臨床上的舒緩,而未能觀察到有明顯的副作用。在2017年,澳洲發布了一項最新的研究,研究中指出UC患者接受FMT中,有27%的患者受益,而 接受安慰劑的患者只有11%受益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 UC 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 UC patients2.

Article Abstract 1:

Fecal Microbiota Transplantation for Ulcerative Colitis: A Systematic Review and Meta-Analysis
. 2016; 11(6): e0157259. Published online 2016 Jun 13. doi:  10.1371/journal.pone.0157259

Twenty five studies (2 randomized controlled trials, 15 cohort studies, and 8 case studies) with 234 UC patients were included. Overall, 41.58% (84/202) patients achieved clinical remission (CR) and 65.28% (126/193) achieved clinical response. Among the cohort studies, the pooled estimate of patients who achieved CR and clinical response were 40.5% (95% CI 24.7%-58.7%), and 66.1% (95% CI 43.7%-83.0%). Most adverse events were slight and self-resolving. The analyses of gut microbiota in 7 studies showed that FMT could increase microbiota diversity and richness, similarity, and certain change of bacterial composition.

Article Abstract 2:

Single Delivery of High-Diversity Fecal Microbiota Preparation by Colonoscopy Is Safe and Effective in Increasing Microbial Diversity in Active Ulcerative Colitis.
Inflamm Bowel Dis. 2017 Jun;23(6):903-911. doi: 10.1097/MIB.0000000000001132.

Recent trials suggest fecal microbiota transplantation (FMT) with repeated enemas and high-diversity FMT donors is a promising treatment to induce remission in ulcerative colitis. Of the 20 patients enrolled in this study, 7 patients (35%) achieved a clinical response by week 4. Three patients (15%) were in remission at week 4 and 2 of these patients (10%) achieved mucosal healing. Three patients (15%) required escalation of care. No serious adverse events were observed. Microbiome analysis revealed that restricted diversity of recipients pre-FMT was significantly increased by high-diversity 2-donor FMP. The microbiome of recipients post-transplant was more similar to the donor FMP than the pretransplant recipient sample in both responders and nonresponders. Notably, donor composition correlated with clinical response.