Alteration of Intestinal Dysbiosis by Fecal Microbiota Transplantation Does not Induce Remission in Patients with Chronic Active Ulcerative Colitis

Kump, Patrizia; Gröchenig, H. P.; Lackner, Sonja; Trajanoski, Slave; Reicht, G; Hoffmann, K. Martin; Deutschmann, Andrea; Wenzl, H; Petritsch, Wolfgang; Krejs, Guenter J.; Gorkiewicz, Gregor; Högenauer, Christoph

doi:10.1097/mib.0b013e31829ea325

Cited by 211 publications

(214 citation statements)

References 44 publications

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“…Most of the studies measured clinical response with regard to patients' symptoms. The diagnoses of IBD was confirmed by pathology in three studies [5,53,55] , the other four studies did not confirm the diagnoses of IBD beyond clinical diagnoses by the treating physician [51,52,54,56] . Pinn et al [57] did not describe criteria for the diagnoses of IBS and included patients with diarrhea-predominant, constipationpredominant and IBS patients with alternating stool pattern.…”

Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

“…CD was located ileocolonic (n = 3) and restricted to the colon (n = 1) in the series published by Vermeire et al [55] . Extent of disease in UC was mostly a pancolitis [52,53] . Response to therapy was measured by five different assessments in UC: patient reporting of symptoms on a questionnaire comparing pre-and post-FMT data [56] ; (clinical) Mayo score [53,60] ; the total Mayo score [51] ; the Paediatric UC Activity Index in children [52] ; and the modified Powell-Tuck index [5] .…”

Section: Ibdmentioning

confidence: 99%

“…A total number of 1029 patients underwent FMT. The clinical efficacy of FMT was assessed in patients with: CDI [2, (n = 883), IBD [5,[51][52][53][54][55][56] (n = 112), IBS [57] (n = 13), pouchitis [9] (n = 8), constipation [58] (n = 3) and metabolic syndrome [10] (n = 10 randomised to the donor feces arm). Age of the included patients varied widely from 6 to 94 years.…”

Section: Patients Treatment Information and Donor Screeningmentioning

confidence: 99%

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Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Rossen

MacDonald

Vries

et al. 2015

WJG

206

123

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AIM:To study the clinical efficacy and safety of Fecal microbiota transplantation (FMT). We systematically reviewed FMT used as clinical therapy. METHODS:We searched MEDLINE, EMBASE, the Cochrane Library and Conference proceedings from inception to July, 2013. Treatment effect of FMT was calculated as the percentage of patients who achieved clinical improvement per patient category, on an intention-to-treat basis. RESULTS:We included 45 studies; 34 on Clostridium difficile -infection (CDI), 7 on inflammatory bowel disease, 1 on metabolic syndrome, 1 on constipation, 1 on pouchitis and 1 on irritable bowel syndrome (IBS). In CDI 90% resolution of diarrhea in 33 case series (n = 867) was reported, and 94% resolution of diarrhea after repeated FMT in a randomized controlled trial (RCT) (n = 16). In ulcerative colitis (UC) remission rates of 0% to 68% were found (n = 106). In Crohn's disease (CD) (n = 6), no benefit was observed. In IBS, 70% improvement of symptoms was found (n = 13). 100% Reversal of symptoms was observed in constipation (n = 3). In pouchitis, none of the patients (n = 8) achieved remission. One RCT showed significant improvement of insulin sensitivity in metabolic syndrome (n = 10). Serious adverse events were rare. SYSTEMATIC REVIEWS CONCLUSION:FMT is highly effective in CDI, and holds promise in UC. As for CD, chronic constipation, pouchitis and IBS data are too limited to draw conclusions. FMT increases insulin sensitivity in metabolic syndrome.

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Section: Risk Of Bias Within Studiesmentioning

confidence: 99%

Section: Ibdmentioning

confidence: 99%

Section: Patients Treatment Information and Donor Screeningmentioning

confidence: 99%

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Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Rossen

MacDonald

Vries

et al. 2015

WJG

206

123

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“…To date, cases of death attributable to FMT due to aspiration pneumonia related to sedation and bacteremic toxic megacolon have been isolated, but underscore the need for robust follow-up to expand the safety data [81][82][83]. Although FMT has demonstrated overall safety among the immunocompromised population, a subset of patients with inflammatory bowel disease (IBD) have been found to experience exacerbation of IBD, fever, or elevated C-reactive protein levels post-FMT treatment [83][84][85][86]. The lack of data and the inherent variability of the microbial composition in donor stool renders the assessment of adverse events challenging.…”

Section: Safetymentioning

confidence: 99%

Recurrent Clostridium difficile infection and the microbiome

2015

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The diverse and densely populated gastrointestinal microbiota is essential for the regulation of host physiology and immune function. As our knowledge of the composition and function of the intestinal microbiota continues to expand, there is new interest in using these developments to tailor fecal microbiota transplantation (FMT) and microbial ecosystem therapeutics (MET) for a variety of diseases. The potential role of FMT and MET in the treatment of Clostridium difficile infection (CDI)-currently the leading nosocomial gastrointestinal infection-has proven highly effective for recurrent CDI, and has emerged as a paradigm shift in the treatment of this disease. The current review will serve as a summary of the key aspects of CDI, and will introduce the essential framework and challenges of FMT, as is currently practiced. MET represents the progression of conventional bacteriotherapy that fundamentally capitalizes on the restorative properties of intestinal bacterial communities and may be viewed as the culmination of a rationally designed therapeutic modality. As our understanding of the composition and function of the intestinal microbiota evolves, it will likely drive next-generation microbiota therapies for a range of medical conditions, such as inflammatory bowel disease, obesity, and metabolic syndrome.

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“…However, in a meta-analysis of cohort studies, the pooled proportion of patients who achieved remission was 36.2 %. In the subgroup analyses, the proportion of UC patients who achieved remission was only 22 % [107][108][109][110][111], and the proportion of CD patients who achieved clinical remission was 60.5 % [112][113][114][115]. Most of the donors were first-degree relatives of these patients.…”

Section: Therapeutic Applications Of Microbiota In Ibdmentioning

confidence: 99%

Gut microbiome diversity in acute infective and chronic inflammatory gastrointestinal diseases in North India

et al. 2016

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The disease profile in the Indian population provides a unique opportunity for studying the host microbiome interaction in both infectious (amebiasis) and autoimmune diseases like inflammatory bowel disease (IBD) from a similar environment and genetic background. Analysis of fecal samples from untreated amebic liver abscess (ALA) patients, Entamoeba histolytica (Eh)-negative and -positive asymptomatic individuals, and pus samples from naive ALA patients revealed a significant reduction in Lactobacillus in asymptomatic individuals (Eh ?ve) and ALA patients. Two anaerobic genera, namely Bacteroides and Peptostreptococcus, were detected in naive ALA pus samples. Analysis of fecal samples from amoebic colitis patients showed a significant decline in population of Bacteroides, Clostridium coccoides and leptum subgroup, Lactobacillus, Campylobacter, and Eubacterium, whereas a significant increase in Bifidobacterium was observed. Mucosa-associated bacterial flora analysis from IBD patients and healthy controls revealed a significant difference in concentration of bacteria among predominating and subdominating genera between ulcerative colitis (UC), Crohn's disease (CD) patients, and controls. In contrast to the mucosal studies, we found a significant increase in lactobacilli population in fecal samples of active UC patients. Another study revealed a significant decrease of Clostridium coccoides and leptum clusters in fecal samples of active UC patients along with decreased concentrations of fecal SCFAs, especially of nbutyrate, iso-butyrate, and acetate. We therefore found similar perturbations in gut microbiome in both infectious and autoimmune diseases, indicating inflammation to be the major driver for changes in gut microbiome.

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Alteration of Intestinal Dysbiosis by Fecal Microbiota Transplantation Does not Induce Remission in Patients with Chronic Active Ulcerative Colitis

Cited by 211 publications

References 44 publications

Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Fecal microbiota transplantation as novel therapy in gastroenterology: A systematic review

Recurrent Clostridium difficile infection and the microbiome

Gut microbiome diversity in acute infective and chronic inflammatory gastrointestinal diseases in North India

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