Fecal Microbiota Transplantation Induces Clinical Remission For Refractory Crohn’s Disease Patient

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Another case report study has once again highlighted the potential therapeutic benefits of using Fecal Microbiota Transplantation for treating refractory Crohn’s disease.

There have now been a number of case reports worldwide and anecdotal reports of individuals successfully using FMT to treat IBD(inflammatory bowel diseases) such as Crohn’s disease and Ulcerative colitis.

Fecal Microbiota Transplantation is an exciting emerging alternative therapy, which is gaining huge popularity in the press due to it’s success for treating recurrent C. difficile infections.

FMT, also referred to as stool/fecal transplantation or fecal bacteriotherapy, is the infusion or engraftment of fecal liquid filtrate from a healthy donor into the gut of a recipient to cure a specific disease.

Recent studies have shown that FMT is an effective treatment in recurrent CDI, with a >90% success rate, and it can be considered as an antibiotic replacement for recurrent and refractory CDI that has relapsed more than three times.

Scientific research has been hugely focused on the vital role and importance of the gut microbiome in recent years when it comes to the pathogenesis of intestinal diseases.

Research has now confirmed that alterations and disturbances of the gut microbiome, also known as dysbiosis to play a role in many common health conditions from autism spectrum disorders to chronic fatigue syndrome, and of course including serious digestive disorders such as Crohn’s disease and Ulcerative Colitis.

Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. [1]

Increased intestinal permeability, also known as “leaky gut” is another common factor involved in the development of Crohn’s and other digestive conditions.

Cui et al. recently published a pilot study in which thirty patients with refractory Crohn’s Disease(CD) were treated with a single FMT through the mid-gut. The rates of clinical improvement and remission based on clinical activity during the first month after FMT were 86.7% (26/30) and 76.7% (23/30), respectively. In addition, the body weights of the patients increased. [3]

The case report we are going to discuss and share below is of a patient with refractory crohn’s disease in whom biological therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single FMT infusion.

Now this is very impressive in my opinion that a single FMT infusion was enough to achieve clinical remission and endoscopic improvement.

FMT For Treating Refractory Crohn’s Disease Case Report

A 16-year-old female patient was admitted to Uijeongbu St. Mary’s Hospital for the management of refractory colonic CD.

CD was diagnosed 1 year prior, according to standard endoscopic and histologic criteria.

CD was remitted with prednisone, and maintenance therapy with mesalazine and 6-mercaptoprine was administered. Four months prior to hospital admission, she was treated with infliximab (5 mg/kg) because of several flares, and she responded well; however, colitis aggravated 1 month before admission. On admission, the patient’s body temperature was 37.1℃, and she had poor general condition.

Her CDAI score was 394; thus, treatment with FMT was discussed with the patient and her parents, and they agreed to treatment.

The FMT procedure was performed on day 12 after hospital admission. The FMT stool source, a family donor, received both blood and stool tests, and HBsAg, anti-HCV, Veneral Disease Research Laboratory test, C. difficile toxin, and human immunodeficiency virus were not detected. The donor had no history of antibiotic use within the past year or any history of chemotherapy.

Sixty grams of stool was mixed in 250 mL of normal saline and homogenized using a mechanical blender. The suspension was filtered through gauze to remove larger particulate matters. FMT was performed using gastroduodenoscopy; the endoscope was inserted into the second portion of the duodenum, and the prepared fecal suspension was transferred to the patient’s bowels through the biopsy channel of the endoscope. The procedure time was approximately 5 minutes.

One day after FMT, the patient developed abdominal pain and a transient fever; however, these symptoms disappeared after conservative care. One week after FMT, the patient felt well and had 1 to 2 formed bowel movements per day with no abdominal pain. The CDAI was reduced to 132, and the patient was discharged.

Although clinical remission was achieved, the patient wished to receive maintenance treatment. After FMT, mesalazine (3.0 g/day) and azathioprine (50 mg/day) was administered for maintenance therapy.

In addition, 2 months after FMT, she was administered infliximab (5 mg/kg) intravenously, to which she responded well, and treatment with infliximab was continued every 2 months.

A follow-up colonoscopy 10 months after FMT showed improvement in the mucosal lesions. Clinical remission was sustained for more than 12 months, and the follow-up is ongoing.

The case report concluded:

In conclusion, this case report suggests that FMT through the mid-gut may be an optimal treatment for refractory CD unresponsive to current conventional therapy, such as anti-inflammatory agents, steroids, immunosuppressives, and biological therapies.

Further prospective randomized studies are necessary to fully assess the safety and efficacy of FMT in patients with IBD.

Overall, FMT is considered relatively tolerable and safe in the short term. [1]

References

[1] Fecal microbiota transplantation for refractory Crohn’s disease

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5430018/

[2] Fecal microbiota transplantation inducing remission in Crohn’s colitis and the associated changes in fecal microbial profile.

https://www.ncbi.nlm.nih.gov/pubmed/24667590

[3] Fecal microbiota transplantation through mid-gut for refractory Crohn’s disease: safety, feasibility, and efficacy trial results.

https://www.ncbi.nlm.nih.gov/pubmed/25168749

The information in this article has not been evaluated by the FDA and should not be used to diagnose, cure or treat any disease, implied or otherwise.

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