Recent Therapeutic Advances in Gastroenterology and Hepatology
نویسندگان
چکیده
The past year has seen major therapeutic advances in gastroenterology and hepatology. Two areas with notable gains are related to infectious diseases: novel treatments directed against recurrent Clostridium difficile infection (CDI) and against the hepatitis C virus (HCV). Clostridium difficile infection is an infectious colitis with high associated morbidity and mortality. Broad-spectrum antibiotics cause CDI by depleting the normal colonic flora and lowering barriers to C. difficile proliferation. Antibiotics directed against C. difficile (i.e., metronidazole and oral vancomycin) have a high initial success rate for CDI, but up to onethird of patients experience recurrence. Historically, recurrent CDI was treated with extended, but often diminishingly effective courses of oral vancomycin [1]. But beginning in the 1980s, an alternative strategy was pursued: feces from a healthy donor was given via enema or colonoscopically to a diseased individual. Called fecal microbiota transplantation (FMT), this technique resulted in durable cure rates over 95%, even among patients with multiple recurrences [2]. But there were problems with FMT. There was no randomized data supporting it, and the testing of donor stool for infectious microorganisms was not standardized. This changed in January 2013 with the results of a randomized study of oral vancomycin followed by FMT with pooled, pre-screened stool versus vancomycin alone. In this trial, 81% of the vancomycin–FMT group versus 27% of the vancomycin alone group experienced resolution of symptoms [3]. Subsequently, FMT has been expanded with studies demonstrating that donor stool can be collected, frozen, and administered later [4] or even impregnated in gel capsules and taken by mouth [5]. In the future, it is likely that specific organisms, selected to compete for resources against C. difficile, will replace FMT for treatment of recurrent CDI. D. E. Freedberg J. A. Abrams (&) Division of Digestive and Liver Diseases, Columbia University Medical Center, 622 W 168th Street, PH 7W 318, New York, NY 10032, USA e-mail: [email protected]
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