腸易激綜合症 Irritable Bowel Syndrome (IBS)

腸易激綜合症會影響消化系統，主要是大腸，小腸也有機會受影響。也被稱為大腸急燥症，粘液性結腸炎，痙攣性大腸或痙攣性結腸炎，以及胃翻騰。某些地區，有1/5的人口受IBS的影響。而在香港，就有大約10％的人口是IBS患者.1。IBS是一種慢性疾病，腸胃會長期地處於不穩定狀態而引起以下症狀：

• 肚瀉
• 便秘
• 痙攣性腹痛
• 大便帶有黏液		 • 大便異常
• 肚脹
• 疲倦
• 虛弱

 

IBS影響在大腸中的菌群生態，引起腸胃超敏反應，會導致腸道蠕動不良（複合位移運動 migrating motor complex）出現便秘情況或因腸道通透性（漏腸 leaky gut）而引起的慢性炎症及疲勞。令外，IBS有機會使小腸中的細菌過度生長（SIBO）或小腸真菌過度生長（SIFO），導致嚴重的肚脹和大便異常的症狀。

如何診斷？

暫時並沒有特定的測試來診斷IBS。如果出現以上的症狀，患者需要作進一步驗查確診。驗查之後發現不是由其他的腸胃疾病，例如潰瘍性大腸炎Ulcerative colitis或 克羅恩症 Crohn’s disease引起的腸胃不適，醫生便可能將您的病情確診為IBS。為了更明確地診斷，醫生會檢閱患者的病歷以及過往的檢報告，並為患者做身體檢查。

國際性IBS診斷條件：

過去3個月內，平均每周至少有1次腹痛，以及 與以下兩項或以上的大便情況相關：

  • 排便不順暢／肚瀉便秘交替發生／排便時總有排不乾淨的
  • 大便習慣改變
  • 大便形、色、質、量的改變

3個月內出現以上相關的大便情況，且在醫生確診前至少6個月出內出現症狀。

如果患者未能符合以上條件，但患者又受著以上腸胃不適的症狀影響，有機會是患上功能性腸胃失調Functional GI Disorder（FGID）。如欲了解更多關於FGID，請點擊這裡。

為什麼選擇人類菌群移植療法 Human Microbiota Transplant（HMT）來舒緩 腸易激綜合症IBS的有關症狀？

腸易激綜合症是一種複雜的多發性腸胃疾病，包括腸道過敏反應，腸-腦相不協調，腸胃發炎和腸道微生菌群失調dysboisis。某一些IBS症狀與腸道微生菌群有關， HMT治療IBS已在一些研究中得到認證。已經有多過1,500名IBS患者接受了HMT治療，而在 HMT治療後獲得正面結果由36％ 上升至64％。在最新的IBS臨床試驗中，超過60％的IBS患者接受糞菌移植後症狀得以舒緩3。

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。

 

Scientific Article Abstract 1:

Faecal microbiota transplantation versus placebo for moderate-to-severe irritable bowel syndrome: a double-blind, randomised, placebo-controlled, parallel-group, single-centre trial

Peter Holger Johnsen, Frank Hilpüsch, Jorunn Pauline Cavanagh, Ingrid Sande Leikanger, Caroline Kolstad, Per Christian Valle, Rasmus Goll

Lancet Gastroenterol Hepatol 2017

Between Jan 1, and Oct 30, 2015, we recruited 90 participants and randomly assigned them to active treatment (n=60) or placebo (n=30). Three participants did not undergo FMT and four were excluded after diagnosis of microscopic colitis, leaving 83 for final modified intention-to-treat analysis (55 in the active treatment group and 28 in the placebo group).

Responders: 36 (65%) of 55 participants receiving active treatment versus 12 (43%) of 28 receiving the placebo showed response at 3 months (p=0·049).

FMT induced significant symptom relief in patients with IBS. However, larger multicentre studies are needed to confirm the results.

 

Article Abstract 2:

Efficacy analysis of fecal microbiota transplantation in the treatment of 406 cases with gastrointestinal disorders

[Article in Chinese]
Li N1, Tian H, Ma C, Ding C, Ge X, Gu L, Zhang X, Yang B, Hua Y, Zhu Y, Zhou Y.

OBJECTIVE:

To evaluate the efficacy and safety of fecal microbiota transplantation (FMT) for gastrointestinal disorders.

METHODS:

Retrospective analysis of the clinical data of 406 patients who underwent FMT from May 2014 to April 2016 in the Intestinal Microenvironment Treatment Centre of Nanjing General Hospital was performed, including patients with constipation(276 cases), recurrent Clostridium Difficile infection (RCDI, 61 cases), ulcerative colitis(44 cases), irritable bowel syndrome (15 cases) and Crohn’s disease(10 cases). Donors were completely unrelated, 18- to 50-year-old non-pregnant healthy adult, with healthy lifestyle and habits, without taking antibiotics, probiotics and other probiotics history within 3 months. There were three routes of FMT administration: patients received 6 days of frozen FMT by nasointestinal tube placed in the proximal jejunum under gastroscope (319 cases); patients received capsules FMT per day for 6 consecutive days (46 cases) or once 600 ml of treated fecal liquid infusion into colon and terminal ileum by colonoscopy(41 cases).

RESULTS:

Clinical cure rate and improvement rate of different diseases receiving FMT were respectively as follows: RCDI was 85.2% (52/61) and 95.1%(58/61); constipation was 40.2%(111/276) and 67.4%(186/276); ulcerative colitis was 34.1%(15/44) and 68.2% (30/44); irritable bowel syndrome was 46.7% (7/15) and 73.3% (11/15) and Crohn disease was 30.0%(3/10) and 60.0%(6/10). RCDI had the best efficacy among these diseases(P<0.01). There was no significant difference between the three routes of FMT administration(P=0.829). The clinical cure rate and improvement rate of different routes were 43.3%(138/319) and 58.6% (187/319) respectively in nasogastric transplantation group, 41.5%(17/41) and 61.0%(25/41) in colonoscopy group, 37.0%(17/46) and 63.0% (29/46) in the capsule transplantation group. There was no serious adverse event during the follow-up. The most common side effects were respiratory discomfort (27.3%, 87/319) and increased venting (51.7%, 165/319) in nasogastric transplantation group. Diarrhea was the most common complication in colonoscopy group (36.6%, 15/41). The main symptoms were increased venting (50.0%, 23/46) and nausea(34.8%, 16/46) in oral capsule group. Side effect symptoms disappeared after the withdraw of nasogastric tube, or at the end of treatment, or during hospitalization for 1-3 days.

CONCLUSIONS:

FMT is effective for many gastrointestinal disorders. No significant adverse event is found, while the associated mechanism should be further explored.

 

Article Abstract 3:

Fecal Microbiota Transplantation Past, Present and Future

Olga C. Aroniadis; Lawrence J. Brandt
Curr Opin Gastroenterol. 2013;29(1):79-84.

“Treatment of Gastrointestinal Diseases: Irritable Bowel Syndrome and Chronic Constipation

Postinfectious IBS has been reported in up to 30% of patients with acute gastroenteritis, suggesting that the pathogenesis of IBS may be intimately linked to an altered intestinal microbiota.[47–49] The composition of the intestinal microbiota in patients with IBS has not been extensively studied, however, patients with constipation-predominant IBS have been shown to increase population of sulphate-reducing bacteria compared with healthy controls.[50] Probiotics can restore the intestinal microbiota in patients with IBS[49,51] and result in improvement of postinfectious IBS in animal models;[11] FMT, however, may prove more beneficial, as donated feces, in a sense, are the ultimate human probiotic.

In a case series of 55 patients with IBS and IBD treated with FMT, cure was reported in 20 (36%), decreased symptoms in nine (16%) and no response in 26 (47%) patients.[6] In another series, 45 patients with chronic constipation were treated with colonoscopic FMT and subsequent fecal enema infusions, 89% of whom (40 of 45 patients) reported relief in defecation, bloating and abdominal pain immediately after the procedure.[52] Normal defecation, without laxative use, persisted in 18 of 30 patients (60%) contacted 9–19 months later.[52]

Article Abstract 4:

FMT improves symptoms, QOL in IBS patients

Healio, Gastroenterology Report
May 8, 2017

“It seems that FMT has a beneficial effect on symptom scores and on quality of life in IBS patients. However, this effect is also observed in the placebo group, although to a lesser extent, but this indicates that placebo controlled studies are definitely necessary in IBS patients,” Savanne Holster, PhD, of the Nutrition-Gut-Brain Interactions Research Center at Örebro University in Sweden, said during her presentation.

Holster and colleagues randomly assigned 16 patients with IBS to receive FMT via colonoscopy using either donor material or their own fecal material as placebo. The researchers assessed symptom scores and quality of life before and after the procedure.

IBS Symptom Severity Scores in patients who received donor FMT dropped significantly at 4 and 8 weeks after treatment compared with baseline (P < .01 for both), while there were no significant changes observed in the placebo group. There were also no significant differences observed in IBS-SSS between the treatment and placebo groups.