Background Fecal microbiota transplantation is an emerging therapeutic option, particularly for the treatment of recurrent Clostridioides difficile infection. Stool banks that organise recruitment and screening of feces donors are being embedded within the regulatory frameworks described in the European Union Tissue and Cells Directive and the technical guide to the quality and safety of tissue and cells for human application, published by the European Council. Objective Several European and international consensus statements concerning fecal microbiota transplantation have been issued. While these documents provide overall guidance, we aim to provide a detailed description of all processes that relate to the collection, handling and clinical application of human donor stool in this document. Methods Collaborative subgroups of experts on stool banking drafted concepts for all domains pertaining to stool banking. During a working group meeting in the United European Gastroenterology Week 2019 in Barcelona, these concepts were discussed and finalised to be included in our overall guidance document about fecal microbiota transplantation. Results A guidance document for all domains pertaining to stool banking was created. This document includes standard operating manuals for several processes involved with stool banking, such as handling of donor material, storage and donor screening. Conclusion The implementation of fecal microbiota transplantation by stool banks in concordance with our guidance document will enable quality assurance and guarantee the availability of donor feces preparations for patients.

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ObjectiveTo evaluate the use, effectiveness and safety ofHelicobacter pyloriempirical rescue therapy in third and subsequent treatment lines in Europe.DesignInternational, prospective, non-interventional registry of the clinical practice of European gastroenterologists. Data were collected and quality reviewed until October 2021 at Asociación Española de Gastroenterología-Research Electronic Data Capture. All cases with three or more empirical eradication attempts were assessed for effectiveness by modified intention-to-treat and per-protocol analysis.ResultsOverall, 2144 treatments were included: 1519, 439, 145 and 41 cases from third, fourth, fifth and sixth treatment lines, respectively. Sixty different therapies were used; the 15 most frequently prescribed encompassed >90% of cases. Overall effectiveness remained <90% in all therapies. Optimised treatments achieved a higher eradication rate than non-optimised (78% vs 67%, p<0.0001). From 2017 to 2021, only 44% of treatments other than 10-day single-capsule therapy used high proton-pump inhibitor doses and lasted ≥14 days. Quadruple therapy containing metronidazole, tetracycline and bismuth achieved optimal eradication rates only when prescribed as third-line treatment, either as 10-day single-capsule therapy (87%) or as 14-day traditional therapy with tetracycline hydrochloride (95%). Triple amoxicillin-levofloxacin therapy achieved 90% effectiveness in Eastern Europe only or when optimised. The overall incidence of adverse events was 31%.ConclusionEmpirical rescue treatment in third and subsequent lines achieved suboptimal effectiveness in most European regions. Only quadruple bismuth-metronidazole-tetracycline (10-day single-capsule or 14-day traditional scheme) and triple amoxicillin-levofloxacin therapies reached acceptable outcomes in some settings. Compliance with empirical therapy optimisation principles is still poor 5 years after clinical practice guidelines update.Trial registration numberNCT02328131.

Kontext a cíl výzkumu: Nealkoholické ztukovatění jater (nonalcoholic fatty liver disease, NAFLD) má závažné ekonomické dopady na zdravotnictví celosvětově a na Ukrajině obzvláště. Hlavní příčinou mortality pacientů s NAFLD jsou kardiovaskulární onemocnění (KVO). Za potenciální mechanismus rozvoje ischemické choroby srdeční (ICHS) u pacientů s NAFLD lze považovat změny ve složení střevní mikrobioty. Cílem našeho výzkumu bylo zjistit změny koncentrací hlavních fylotypů střevní mikrobioty, kmenů Bacteroidetes, Firmicutes a Actinobacteria, a kvantifi kovat koncentrace kmenů Firmicutes/Bacteroidetes u pacientů s NAFLD a současně s ICHS. Materiál a metody: Do studie bylo zařazeno 109 jedinců s NAFLD (25 současně s arteriální hypertenzí [AH] a 24 současně s ICHS). Složení střevní mikrobioty bylo hodnoceno metodou qPCR. Výsledky a závěry: U obou podskupin, s ICHS a s AH jako komorbiditami, byl pozorován výrazný trend ke zvyšování koncentrací Bacteroidetes (o 37,11 %, resp. 21,30 %) a snižování koncentrací kmene Firmicutes (o 7,38 %, resp. 7,77 %), přičemž nalezené změny nedosahovaly statistické významnosti. Ve srovnání s pacienty pouze s NAFLD bylo u nemocných s NAFLD plus ICHS zaznamenáno statisticky významné snížení koncentrací kmene Actinobacteria o 41,37 % (p ˂ 0,05). U pacientů s NAFLD plus AH byly koncentrace kmene Actinobacteria nižší o 12,35 % (statisticky nevýznamný rozdíl). Byly nalezeny změny ve složení střevní mikrobioty, konkrétně nižší koncentrace kmene Actinobacteria u pacientů s ICHS; toto zjištění si vyžádá další výzkum.

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