1. Inflammatory bowel disease outcomes following fecal microbiota transplantation for recurrent C. difficile infection
- Author
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Benjamin H. Mullish, Monika Fischer, Jonathan Hurtado, Sashidhar Sagi, Zain Kassam, Colleen R. Kelly, Sara Nemes, Ari Grinspan, Michael Silverstein, Matthew Bohm, Will Pettee, James L. Alexander, Madeline Carrellas, Jesus Miguens Blanco, Julian Marchesi, Alexandros Pechlivanis, Emmalee Phelps, Jenna Marcus, Julie A. K. McDonald, Ylaine Gerardin, Kate Gallagher, Jessica R. Allegretti, Grace F. Barker, Medical Research Council, Medical Research Council (MRC), Imperial College Healthcare NHS Trust- BRC Funding, and Versus Arthritis
- Subjects
0301 basic medicine ,Crohn’s disease ,medicine.medical_specialty ,Colonoscopy ,microbiome ,Disease ,Gastroenterology ,Inflammatory bowel disease ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Recurrence ,inflammatory bowel disease ,Internal medicine ,Immunology and Allergy ,Medicine ,Humans ,Prospective Studies ,ulcerative colitis ,Crohn's disease ,medicine.diagnostic_test ,Gastroenterology & Hepatology ,business.industry ,Clostridioides difficile ,fecal microbiota transplantation ,Retrospective cohort study ,1103 Clinical Sciences ,medicine.disease ,butyrate ,Ulcerative colitis ,digestive system diseases ,030104 developmental biology ,Treatment Outcome ,Clostridioides difficile infection ,Cohort ,Clostridium Infections ,030211 gastroenterology & hepatology ,Colitis, Ulcerative ,Leading Off ,business ,Cohort study - Abstract
Background Recurrent Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is a clinical challenge. Fecal microbiota transplantation (FMT) has emerged as a recurrent CDI therapy. Anecdotal concerns exist regarding worsening of IBD activity; however, prospective data among IBD patients are limited. Methods Secondary analysis from an open-label, prospective, multicenter cohort study among IBD patients with 2 or more CDI episodes was performed. Participants underwent a single FMT by colonoscopy (250 mL, healthy universal donor). Secondary IBD-related outcomes included rate of de novo IBD flares, worsening IBD, and IBD improvement—all based on Mayo or Harvey-Bradshaw index (HBI) scores. Stool samples were collected for microbiome and targeted metabolomic profiling. Results Fifty patients enrolled in the study, among which 15 had Crohn’s disease (mean HBI, 5.8 ± 3.4) and 35 had ulcerative colitis (mean partial Mayo score, 4.2 ± 2.1). Overall, 49 patients received treatment. Among the Crohn’s disease cohort, 73.3% (11 of 15) had IBD improvement, and 4 (26.6%) had no disease activity change. Among the ulcerative colitis cohort, 62% (22 of 34) had IBD improvement, 29.4% (11 of 34) had no change, and 4% (1 of 34) experienced a de novo flare. Alpha diversity significantly increased post-FMT, and ulcerative colitis patients became more similar to the donor than Crohn’s disease patients (P = 0.04). Conclusion This prospective trial assessing FMT in IBD-CDI patients suggests IBD outcomes are better than reported in retrospective studies.
- Published
- 2020