Fecal Microbiota Transplantation in Pouchitis: Clinical, Endoscopic, Histologic, and Microbiota Results from a Pilot Study

Promise of Fecal Microbiota Transplantation Therapy in Pouchitis

“…Profiling of the bacteriome showed that communitylevel differences were restricted to comparisons between donors and patients with pouchitis regardless of FMT, with donors showing higher phylogenetic diversity [7]. No shifts in patients' community profiles toward donor profiles were evident, unlike previous studies examining FMT in pouchitis [5,6].…”

“…No shifts in patients' community profiles toward donor profiles were evident, unlike previous studies examining FMT in pouchitis [5,6]. Selvig et al [7] identified specific bacterial taxa that differed in relative abundances across groups, the most robust differences being higher levels of anaerobic fermenters that produce short-chain fatty acids in the donors. Nevertheless, the authors did not report any changes in taxa abundances post-FMT.…”

“…Specifically, Stallman et al reported endoscopic response in all patients (n = 5) and endoscopic remission in one patient (20%) following FMT infusions (n = 1-7 instillations) [6]. Selvig et al [7] also report statistically significant improvement in bowel frequency, which was particularly evident in patients receiving rifaximin pre-FMT and a second FMT instillation. These observations align well with a recent report of severe diversion ileitis and pouchitis in a patient with a history of ulcerative pancolitis, in whom multiple autologous FMT infusions were required for successful treatment, leading to an increase in Firmicutes and decrease in Proteobacteria in the ileal pouch [8].…”

“…In this issue of Digestive Diseases and Sciences, Selvig et al [7] report on the largest study of FMT therapy in pouchitis to date. While post-FMT Pouchitis Disease Activity Index (PDAI) scores were not available for all patients and some had PDAI scores ≤ 6 pre-FMT [7], the slight improvements in endoscopic and histological outcomes are supported by the only other pouchitis study reporting these data. Specifically, Stallman et al reported endoscopic response in all patients (n = 5) and endoscopic remission in one patient (20%) following FMT infusions (n = 1-7 instillations) [6].…”

“…At present, with respect to FMT for pouchitis, there is a paucity of available data, a high degree of heterogeneity among studies, and lack of randomized controlled trials for either induction or maintenance (Table 1) [4-7, 9, 10]. Though the study by Selvig et al [7] provides further patient data, clarity is still missing in many aspects. The use of antibiotics (rifaximin) pre-FMT in pouchitis is interesting, although its impact is unclear as only a small subset of patients received this treatment (7/19).…”