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Inflammatory bowel disease outcomes following fecal microbiota transplantation for recurrent C. difficile infection

Allegretti, Jessica R., Kelly, Colleen R., Grinspan, Ari, Mullish, Benjamin H., Hurtado, Jonathan, Carrellas, Madeline, Marcus, Jenna, Marchesi, Julian R., McDonald, Julie A.K., Gerardin, Ylaine, Silverstein, Michael, Pechlivanis, Alexandros, Barker, Grace F., Miguens Blanco, Jesus, Alexander, James L., Gallagher, Kate I., Pettee, Will, Phelps, Emmalee, Nemes, Sara, Sagi, Sashidhar V., Bohm, Matthew, Kassam, Zain and Fischer, Monika 2021. Inflammatory bowel disease outcomes following fecal microbiota transplantation for recurrent C. difficile infection. Inflammatory Bowel Diseases 27 (9) , 1371–1378. 10.1093/ibd/izaa283

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Biosciences
Publisher: Wiley: No OnlineOpen / Lippincott, Williams & Wilkins
ISSN: 1078-0998
Date of First Compliant Deposit: 14 January 2022
Date of Acceptance: 2 October 2020
Last Modified: 24 Jan 2022 16:55
URI: https://orca.cardiff.ac.uk/id/eprint/146707

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