ABSTRACT
Fecal microbiome transfer (FMT) involving the transfer of the microbiome of healthy stool donors to patients with various diseases has been performed in Germany in clinical studies and individual treatment attempts. There is no doubt that FMT is an effective therapeutic principle for recurrent Clostridium difficile infection and ulcerative colitis. From a medico-legal point of view, it should be stressed that, in Germany, the microbiome to be transferred is regarded as a drug, the manufacture of which is subject to the Medicines Act and the risk information from the Federal Institute for Drugs and Medical Devices. The background of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and the potential risk of transmitting pathogens must also be considered. There is an obligation to notify the competent state authorities to perform FMTs in the context of individual treatment attempts. In the context of the limited availability and the fundamental problem of infection, future studies aim to identify the therapeutically active components in the microbiome. Recombinant production is the aim. Initial results represent preliminary steps, as these concepts are not yet established in clinical practice.
Subject(s)
COVID-19 , Clostridioides difficile , Clostridium Infections , Clostridium Infections/therapy , Fecal Microbiota Transplantation/adverse effects , Humans , SARS-CoV-2Subject(s)
Attitude to Health , COVID-19 Vaccines/therapeutic use , COVID-19 , Directive Counseling/methods , Inflammatory Bowel Diseases , Patient Acceptance of Health Care , Vaccination , Adult , COVID-19/epidemiology , COVID-19/prevention & control , Female , Germany/epidemiology , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/psychology , Inflammatory Bowel Diseases/therapy , Influenza Vaccines/therapeutic use , Male , Patient Acceptance of Health Care/psychology , Patient Acceptance of Health Care/statistics & numerical data , Risk Assessment , SARS-CoV-2 , Surveys and Questionnaires , Vaccination/methods , Vaccination/psychologyABSTRACT
In order to improve the care of patients with chronic inflammatory bowel diseases during the coronavirus disease 2019 (COVID-19) pandemic, the currently valid guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases (DGVS) on Crohn's disease and ulcerative colitis were extended within a virtual conference to include current and practically relevant recommendations. The addendum addresses in particular the risk of COVID-19 infections in patients with chronic inflammatory bowel diseases, the diagnostics under the conditions of the pandemic, the consequences for the pharmacotherapy and operative treatment of the underlying disease. It also addresses general measures for protection against infections and for adjunctive treatment of patients with chronic inflammatory bowel diseases.