The Effectiveness of Oral Vancomycin on Inflammatory Bowel Disease in Patients With Primary Sclerosing Cholangitis: A Systematic Review.

IF 4.5 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Inflammatory Bowel Diseases Pub Date : 2024-11-04 DOI:10.1093/ibd/izae257

Naik Arbabzada, Liz Dennett, Guanmin Meng, Farhad Peerani

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Abstract

Background: Approximately 70% of primary sclerosing cholangitis (PSC) patients have inflammatory bowel disease (IBD). The IBD therapies currently used to treat PSC-IBD patients have side effects and can be costly. Oral vancomycin (OV)-a safe, economical, and convenient therapy-has been reported to be a salvage therapy in refractory PSC-IBD patients. This systematic review aims to summarize the current literature regarding the effectiveness and safety of OV to treat IBD in PSC patients.

Methods: A systematic literature review of Scopus, Embase, Web of Science, MEDLINE, and CINAHL was performed until March 2024. The Murad scale, Newcastle-Ottawa scale, and Cochrane Collaboration Risk of Bias Tool were used to determine the quality of the case reports and case series, cohort studies, and randomized controlled trial (RCT), respectively. The outcomes sought were response or remission across clinical, biochemical, endoscopic, and histological parameters.

Results: Of the 1725 published studies, we identified 9 case reports, 7 case series, 3 cohort studies, and 1 RCT. Most studies reported an improvement in clinical IBD symptoms such as diarrhea and hematochezia. Fewer publications provided supporting objective data in the form of fecal calprotectin, endoscopic Mayo scores, and histology. There were no reports of vancomycin-resistant enterococci infections.

Conclusions: Oral vancomycin appears safe and effective to treat IBD in a subset of PSC patients. Future studies would benefit from prospective data collection incorporating standardized symptomatic, endoscopic, and histologic indices. Ultimately, a well-powered RCT is needed to better assess the effectiveness, safety, and durability of OV therapy.

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口服万古霉素对原发性硬化性胆管炎患者炎症性肠病的疗效：系统回顾

背景：约 70% 的原发性硬化性胆管炎（PSC）患者患有炎症性肠病（IBD）。目前用于治疗原发性硬化性胆管炎（PSC-IBD）患者的 IBD 疗法有副作用且费用昂贵。据报道，万古霉素口服液（OV）是一种安全、经济、方便的疗法，可作为难治性 PSC-IBD 患者的挽救疗法。本系统性综述旨在总结目前有关 OV 治疗 PSC 患者 IBD 的有效性和安全性的文献：截至 2024 年 3 月，对 Scopus、Embase、Web of Science、MEDLINE 和 CINAHL 进行了系统性文献综述。采用穆拉德量表、纽卡斯尔-渥太华量表和 Cochrane 协作偏倚风险工具分别确定病例报告和系列病例、队列研究和随机对照试验（RCT）的质量。研究结果为临床、生化、内镜和组织学参数的反应或缓解：在已发表的 1725 项研究中，我们发现了 9 项病例报告、7 项病例系列研究、3 项队列研究和 1 项随机对照试验。大多数研究报告称腹泻和血尿等 IBD 临床症状有所改善。较少文献提供了粪便钙蛋白、内镜下梅奥评分和组织学方面的客观数据支持。没有关于耐万古霉素肠球菌感染的报道：结论：口服万古霉素治疗部分PSC患者的IBD似乎安全有效。未来的研究将受益于纳入标准化症状、内镜和组织学指标的前瞻性数据收集。最终，还需要进行有充分证据支持的 RCT 研究，以更好地评估口服万古霉素治疗的有效性、安全性和持久性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Inflammatory Bowel Diseases 医学-胃肠肝病学

CiteScore

9.70

自引率

6.10%

发文量

462

审稿时长

1 months

期刊介绍： Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.