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Z Gastroenterol 2014; 52(12): 1485-1492
DOI: 10.1055/s-0034-1385562
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© Georg Thieme Verlag KG Stuttgart · New York

Empfehlungen zur Anwendung der fäkalen Mikrobiotatransplantation „Stuhltransplantation“: Konsensus der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) in Zusammenarbeit mit der Österreichischen Gesellschaft für Infektiologie und Tropenmedizin (OEGIT)

Recommendations for the use of faecal microbiota transplantation „stool transplantation“: consensus of the Austrian Society of Gastroenterology and Hepatology (ÖGGH) in cooperation with the Austrian Society of Infectious Diseases and Tropical Medicine
P. K. Kump
1   Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz
,
R. Krause
2   Sektion Infektiologie und Tropenmedizin, Universitätsklinik für Innere Medizin, Medizinische Universität Graz
,
C. Steininger
3   Klinische Abteilung für Infektionen und Tropenmedizin, Medizinische Universität Wien
,
H. P. Gröchenig
4   Medizinische Abteilung, Krankenhaus der Barmherzigen Brüder, St. Veit an der Glan
,
A. Moschen
5   Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck
,
C. Madl
6   4. Medizinische Abteilung mit Gastroenterologie, Hepatologie und Zentralendoskopie, Krankenanstalt Rudolfstiftung, Wien
,
G. Novacek
7   Abt. Gastroenterologie & Hepatologie, Univ.-Klinik Innere Medizin III, Wien
,
F. Allerberger
8   Österreichische Agentur für Gesundheit und Ernährungssicherheit, AGES, Wien
,
C. Högenauer
1   Klinische Abteilung für Gastroenterologie und Hepatologie, Medizinische Universität Graz
› Author Affiliations
Further Information

Publication History

17 June 2014

13 October 2014

Publication Date:
04 December 2014 (online)

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Zusammenfassung

Die intestinale Mikrobiota hat für die Erhaltung der Gesundheit des menschlichen Organismus eine zentrale Bedeutung und dient insbesondere auch der Abwehr von intestinalen Pathogenen. Veränderungen der intestinalen Mikrobiota, auch als Dysbiose bezeichnet, spielen eine entscheidende Rolle in der Pathogenese von vielen Erkrankungen. Als fäkale Mikrobiotatransplantation (FMT) oder Stuhltransplantation wird die Übertragung von Stuhlmikroorganismen eines gesunden Spenders in den Gastrointestinaltrakt eines erkrankten Patienten bezeichnet, um ein gestörtes Mikrobiom zu behandeln. Die Indikation zu dieser therapeutischen Intervention ist zumeist die rezidivierende Clostridium-difficile-Infektion (CDI). Mittlerweile gibt es bei dieser Indikation überzeugende Daten von einigen großen nicht kontrollierten Studien und einer kontrollierten randomisierten Studie sowie Beobachtungsstudien bei einer großen Anzahl an Patienten. Daher wird die FMT mittlerweile von internationalen Fachgesellschaften bei rezidivierender CDI mit hoher Evidenz empfohlen. Andere potenzielle Indikationen für die FMT sind die fulminante CDI und chronisch-entzündliche Darmerkrankungen. Bei der Anwendung der FMT bestehen vielen offene Fragen für die Praxis v. a. bez. Voruntersuchungen des Spenders, der Aufbereitung des Stuhl- sowie des Applikationswegs. Es sind unterschiedliche Applikationsformen beschrieben worden, wobei die Verabreichung der FMT in den unteren Gastrointestinaltrakt wegen weniger Nebenwirkungen gegenüber der Gaben in den oberen Gastrointestinaltrakt zu bevorzugen ist. Die vorliegenden Publikationen berichten nur über wenige schwere Nebenwirkungen der FMT. Trotzdem wird diese Therapieform derzeit v. a. wegen potenzieller Sicherheitsaspekte und Unklarheiten bez. des rechtlichen Status heftig in Fachkreisen diskutiert. Dieser Konsensusreport der Österreichischen Gesellschaft für Gastroenterologie und Hepatologie (ÖGGH) in Kooperation mit der Österreichischen Gesellschaft für Infektionskrankheiten und Tropenmedizin dient daher Ärzten, die diese Methode benutzen, als eine Anleitung für deren Anwendung basierend auf Daten der rezenten medizinischen Literatur.

Abstract

The intestinal microbiota has a pivotal role in the maintenance of health of the human organism, especially in the defense against pathogenic microorganisms. Alterations in the microbiota, also termed dysbiosis, seem to be involved in the pathogenesis of a variety of intestinal and extraintestinal diseases. Fecal microbiota transplantation (FMT), also known as stool transplantation, is a therapeutic procedure aiming at restoring an altered intestinal microbiota by administration of stool microorganisms from a healthy donor into the intestinal tract of a patient. FMT is most commonly used for recurrent forms of Clostridium difficile infections (CDI). There are currently many cohort studies in a large number of patients and a randomized controlled trial showing a dramatic effect of FMT for this indication. Therefore FMT is recommended by international medical societies for the treatment of recurrent CDI with high scientific evidence. Other potential indications are the treatment of fulminant CDI or the treatment of inflammatory bowel diseases. In the practical utilization of FMT there are currently several open questions regarding the screening of stool donors, the processing of stool and the mode of FMT application. Different modes of FMT application have been described, the application into the colon has to be preferred due to less reported side effects than the application into the upper gastrointestinal tract. So far only very few side effects due to FMT have been reported, nevertheless the use and risks of FMT are currently intensely debated in the medical community. This consensus report of the Austrian society of gastroenterology and hepatology (ÖGGH) in cooperation with the Austrian society of infectious diseases and tropical medicine provides instructions for physicians who want to use FMT which are based on the current medical literature.

Schlüsselwörter

pseudomembranöse Kolitis - chronisch-entzündliche Darmerkrankung - infektiöse Kolitis

Key words

pseudomembranous colitis - chronic inflammatory bowel disease - infectious colitis
 

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