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PWE-078 A Prospective Controlled Pilot Study of Fecal Microbiota Transplantation for Chronic Refractory Pouchitis
  1. J Landy1,2,
  2. H O Al-Hassi2,
  3. E R Mann2,
  4. S T Peake3,
  5. S D McLaughlin4,
  6. Z L Perry-Woodford5,
  7. P J Ciclitira6,
  8. J Nicholls7,
  9. S K Clark8,
  10. S C Knight2,
  11. A L Hart1
  1. 1St Mark’s IBD Unit, St Mark’s Hospital
  2. 2APRG, Imperial College
  3. 3IBD Unit, St Mark’s Hospital, London
  4. 4Gastroenterology, Royal Bournemouth and Christchurch Hospitals, Bournemouth
  5. 5Pouch Care, St Mark’s Hospital
  6. 6Gastroenterology, St Thomas’ Hospital
  7. 7Biosurgery and Surgical Technology, Imperial college
  8. 8Colorectal Surgery, St Mark’s Hospital, London, UK

Abstract

Introduction Faecal microbiota transplantation (FMT) is an effective therapy for Clostridium difficile and possibly inflammatory bowel diseases (IBD). Published data of FMT for inflammatory bowel diseases are reported in case series and case reports. To our knowledge, there are no controlled studies of FMT for IBD. We aimed to conduct a prospective study of FMT for chronic refractory pouchitis.

Methods Patients with clinically, endoscopically and histologically confirmed chronic refractory pouchitis; with a pouch disease activity index (PDAI) > 7 were included. Donors were screened by clinical history and serology for HAV, HBV, HCV, HEV, Treponema, HIV, HTLV I/II and stool for M, C+S, C. difficile toxin and parasites. Fresh donor stool was collected within six hours of nasogasric administration of FMT. Stool samples were also collected from patients for analysis of coliform sensitivities before and 4 weeks after FMT. PDAI and Cleveland global quality of life score (CGQoL ) were recorded prior to FMT and four weeks after FMT.

Results Eight patients with chronic refractory pouchitis who had undergone restorative proctocolectomy for ulcerative colitis underwent FMT. Three patients had ESBL resistant coliforms on stool analysis prior toFMT. Two of these patients demonstrated a change to ciprofloxacin sensitive coliform following FMT. The mean PDAI prior to FMT was 12. The mean CGQoL was 0.45. At 4 weeks following FMT, no patient had achieved a clinical remission (mean PDAI 11). No improvement in CGQoL was seen (mean 0.44).

Conclusion FMT via nasogastric administration was not effective in achieving clinical remission for chronic refractory pouchitis at 4 weeks after FMT. However, in two patients with ESBL resistant coliform, ciprofloxacin sensitivity was regained following FMT and these patients have subsequently been maintained on ciprofloxacin. This suggests FMT may alter the pouch microbiota. Further molecular microbiological analysis is being undertaken to determine the effect FMT had on these patients’ microbiota. In addition, further studies of FMT are required to assess the effect of different methods of FMT that may be more efficacious for this group of patients.

Disclosure of Interest None Declared.

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