Faecal Transplant (FT) and IBD

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I have explored the role of appropriate transplantation in the resolution of MRSA infection that fails to resolve with antibiotic therapy, and have intimated that other conditions of the bowel and linked tissues may also benefit. The model is: that loss of mucosal tolerance underlies the pathology of inflammatory bowel disease and is also linked to irritable bowel syndrome. These altered states of function reflect a combination of environmental, genetic and emotional events that coalesce into a wide range of conditions.

Given the role of the gastrointestinal microbiota in driving inflammation in IBD, treatments that manipulate the microbiota have been investigated including the use of probiotics and prebiotics, with variable evidence for their efficacy.[1]

The consequences of loss of mucosal tolerance, as discussed many times on this site, extend well beyond the local tissues and have systemic effects as well. However the key component of this mini review is to look at the potential role of faecal transplant therapy in the resolution of IBD.

An additional alternative treatment for the management of IBD is faecal microbiota transplantation (FMT), which is the transfer of gastrointestinal microbiota from a healthy donor, via infusion of a liquid stool suspension, to restore the intestinal microbiota of a diseased individual.[2],[3],[4]

FT therapy represents a return to historical concepts with contemporary comprehension

A series of 9 articles have covered the relationship between the clinical use of FT and IBD, although these are all case studies or case reports and do not meet the more stringent standards of a randomised clinical trial.

A further eight have been published where FT was for the treatment of infectious diarrhoea in IBD. These combined 17 articles reported on 41 patients with IBD (27 UC, 12 Crohn’s, 2 unclassified) with a follow-up period of between 2 weeks and 13 years.

Donors were healthy adults who had no antibiotics in the preceding 6–8 weeks (n = 16) or preceding 6 months (n = 10) and underwent viral screening for human immunodeficiency virus, hepatitis, cytomegalovirus, Epstein–Barr virus and C. difficile toxin as well as screening for parasites, ova and bacterial pathogens (n = 34). The relationship of the donor to the patient varied and comprised healthy relatives, partners, friends or unrelated donors.

Where reported, FMT was administered via colonoscopy/enema (26/33) or via enteral tube (7/33). In patients treated for their IBD, the majority experienced a reduction of symptoms (19/25), cessation of IBD medications (13/17) and disease remission (15/24).

Comment

Whilst early days in terms of data collection, this implies a future role in the management of IBD related events



[1] Meijer BJ, Dieleman LA. Probiotics in the treatment of human inflammatory bowel diseases: update 2011. J Clin Gastroenterol 2011; 45: S139–44. View Abstract

[2] Gough E, Shaikh H, Manges AR. Systematic review of intestinal microbiota transplantation (fecal bacteriotherapy) for recurrent Clostridium difficile infection. Clin Infec Dis 2011; 53: 994–1002 View Abstract

[3] Borody TJ, Khoruts A. Fecal microbiota transplantation and emerging applications. Nat Rev Gastroenterol Hepatol 2011; 9: 88–96. View Abstract

[4] Landy J, Al-Hassi HO, McLaughlin SD, et al. Review article: faecal transplantation therapy for gastrointestinal disease. Aliment Pharmacol Ther 2011; 34: 409–15. View Abstract

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2 Comments. Leave new

  • Hi, which paper mentions the 12 Crohn’s disease patients? I’ve downloaded a lot of journal articles on FMT and IBD but have found only 1 case of Crohn’s mentioned. Thanks

    Reply
    • Hi Josh

      The review article referred to in the post is:
      Anderson JL, Edney RJ, Whelan K. Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease. Aliment Pharmacol Ther. 2012 Sep;36(6):503-16. http://tinyurl.com/8d3bjt2

      Reply

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