Faecal microbiota transplantation (FMT) with dietary therapy for acute severe ulcerative colitis

Day, Alice; Yao, Chu K; Bryant, Robert V.

doi:10.1136/bcr-2019-233135

Cited by 22 publications

(14 citation statements)

References 18 publications

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“…While the pilot nature of this project means that significant associations could not be identified, there was a trend towards participants who met the fibre target having lower symptom severity scores for abdominal pain and incomplete bowel motions, but higher symptom severity scores for flatulence. This trend is in line with our hypothesis that a high fibre diet may assist with the maintenance of new microbiota introduced by FMT human studies [ 13 , 14 , 15 , 32 ] and subsequently sustaining increases in beneficial short chain fatty acids [ 33 ]. Previous work in individuals with IBS suggests that low dose prebiotic supplementation of < 6 g may be associated with improved symptoms, while higher doses or inulin-type fructan supplements may increase gastrointestinal symptoms, such as bloating and flatulence [ 34 ].…”

Section: Discussionsupporting

confidence: 88%

Dietary Intakes of Recipients of Faecal Microbiota Transplantation: An Observational Pilot Study

et al. 2021

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This study reports on the dietary intake of recipients of faecal microbiota transplantation (FMT), comparing this with dietary guidelines, and investigates the relationship between dietary intake and clinical outcomes. Males and females aged ≥ 16 years with irritable bowel syndrome or inflammatory bowel disease undergoing FMT were invited to complete validated symptom and quality of life (QOL) questionnaires and three-day weighed food diaries. Descriptive statistics were calculated for symptom scores, QOL scores, nutrients, and food group servings, and compared to Australian population norms, nutrient reference values, and dietary guidelines. The relationship between dietary intake, symptoms, and QOL was assessed. Participants (n = 18) reported baseline symptoms of urgency, abdominal pain, nausea, and bloating and reduced QOL. Of the participants who completed food diaries, 8/14 met the recommended 30 g of fibre when including supplements. Participants met the recommendations for micronutrients and food groups except calcium, fruit, and dairy/dairy alternatives. There was a non-significant trend towards lower symptom severity scores in participants who met the fibre target. The high degree of variability in participant fibre intakes highlights diet as a key variable that has not been previously controlled for in FMT intervention studies. Future studies examining FMT should include dietary analysis of habitual intake of the recipients and donors.

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Section: Discussionsupporting

confidence: 88%

Dietary Intakes of Recipients of Faecal Microbiota Transplantation: An Observational Pilot Study

et al. 2021

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“…Beyond a single pilot study, longevity of efficacy of FMT following an induction regimen is limited. Sood et al reported significantly higher rates of endoscopic and histological remission using 8‐weekly FMT via colonoscopy following a rigorous multi‐session FMT induction, with no difference in steroid‐free remission between FMT and placebo groups at 48 weeks 6,9 . Only one other FMT study in UC has provided functional metagenomic data, similarly showing an increase in alpha‐diversity following FMT in those who achieved remission, as well as enrichment in SCFA‐producing organisms including E .…”

Section: Discussionmentioning

confidence: 99%

“…Single‐donor FMT was prepared and administered as per a previously described protocol 6 . Following a polyethylene glycol bowel preparation, 200 mL of thawed fecal suspension was instilled into the patient's caecum via colonoscopy.…”

Section: Case Reportmentioning

confidence: 99%

“…Emerging observational data suggest modulation of fermentable fibers, total protein, and sulfur proteins, and sulfated food additives, strategies central to the 4‐SURE diet ( FOUR strategies to Sulphide‐RE duction), are efficacious in inducing clinical and endoscopic response in UC 5 . Moreover, a single case report used combined FMT and 4‐SURE diet as therapy and reported induction and maintenance of clinical and endoscopic remission out to 12 months 6 …”

Section: Introductionmentioning

confidence: 99%

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Fecal microbiota transplantation augmented by a sulfide‐reducing diet for refractory ulcerative colitis: A case report with functional metagenomic analysis

Bryant

Day

McGrath³

et al. 2021

JGH Open

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Fecal microbiota transplantation (FMT) is effective for induction of remission in ulcerative colitis (UC). Diet has potential to augment the efficacy and durability of FMT by encouraging engraftment of transplanted microorganisms. A trial of FMT combined with a defined diet was undertaken as salvage therapy for a 71‐year‐old woman with active steroid‐refractory extensive UC. A multidimensional sulfide‐reducing diet (4‐SURE diet) was commenced followed by single‐donor FMT administered by colonoscopy and then enemas over 7 days. Dietary adherence, clinical evaluation, and stool samples for metagenomic profiling were undertaken at weeks 0, 4, 8, and 24. Colonoscopy was performed 8 weeks post‐FMT. Shotgun metagenomic profiling of the donor fecal suspension was also performed. A rapid clinical response to FMT and 4‐SURE diet was observed with normalization of stool frequency (≤2 motions/day) and resolution of rectal bleeding within 2 weeks. Dietary adherence was excellent. Colonoscopy at week 8 revealed no evidence of active colitis (Mayo endoscopic sub‐score 0) with histology showing no evidence of acute or chronic lamina propria inflammatory cell infiltrate. Sustained clinical and endoscopic remission out to 24 weeks was observed. Metagenomic sequencing confirmed sustained engraftment of beneficial donor microbiota with increased alpha‐diversity and capacity for short‐chain fatty acid production, including Faecalibacterium prauznitzii and Eubacterium hallii. This case report supports the rationale of prescribed diet therapy to support engraftment of donor microbiota following FMT for UC. Further large trials with a diet‐arm control group are needed to evaluate FMT augmented by a defined diet in UC.

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“…There are reports that the use of FMT in patients with UC resulted in long-term clinical remission, which necessitates further research in this field. Costello et al [79] presented a case of a 19-year-old man treated in the past with mesalazine, azathioprine and infliximab, currently with a severe UC relapse, who received FMT with a very good effect-the patient was in clinical and endoscopic remission 8 weeks after FMT. Additionally, after 12 months of follow-up, the patient was in clinical and endoscopic remission of UC.…”

Section: Fecal Microbiota Transplantation In Inflammatory Bowel Diseasesmentioning

confidence: 99%

Probiotics, Prebiotics and Synbiotics in Inflammatory Bowel Diseases

Akutko

Stawarski

2021

JCM

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Inflammatory bowel diseases (IBD), which include Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory diseases of the digestive tract with periods of remission and relapses. The etiopathogenesis of IBD is multifactorial and has not been fully understood. Hence, only symptomatic treatment of these diseases is possible. The current pharmacological treatment has variable efficacy and is associated with the risk of significant side effects. Therefore, there is a constant need to search for new types of therapies with a high safety profile. Considering that the qualitative and quantitative profile of the gastrointestinal microbiome is often different in patients with IBD than in healthy individuals, there is a need for looking for therapies aimed at restoring intestinal microbiome homeostasis. Thus, the use of strictly defined probiotics, prebiotics and synbiotics may become an alternative form of IBD therapy. There is evidence that treatment with certain probiotic strains, e.g., VSL#3 and Escherischia coli Nissle 1917, is an effective form of therapy to induce remission in patients with mild to moderate UC. So far, the effectiveness of the use of probiotics, prebiotics and synbiotics in inducing or maintaining remission in patients with CD has not been confirmed. There are also reports of possible beneficial effects of fecal microbiota transplantation (FMT) on the course of IBD, especially UC. Further, well-planned studies on a large group of patients are needed to determine the role of specific probiotic strains, prebiotics, synbiotics and FMT in the treatment of IBD in adults and in children.

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Faecal microbiota transplantation (FMT) with dietary therapy for acute severe ulcerative colitis

Cited by 22 publications

References 18 publications

Dietary Intakes of Recipients of Faecal Microbiota Transplantation: An Observational Pilot Study

Dietary Intakes of Recipients of Faecal Microbiota Transplantation: An Observational Pilot Study

Fecal microbiota transplantation augmented by a sulfide‐reducing diet for refractory ulcerative colitis: A case report with functional metagenomic analysis

Probiotics, Prebiotics and Synbiotics in Inflammatory Bowel Diseases

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