Background/AimsFour high-quality randomized controlled trials have proven the efficacy of fecal microbiota transplantation (FMT) in active ulcerative colitis (UC). We assessed the efficacy of FMT in a real-world setting involving steroid-dependent patients with UC.MethodsThis was a single-center prospective analysis of data from steroid-dependent patients with UC treated with FMT from September 2015 to September 2017 at the Dayanand Medical College, a tertiary care center in India. Fecal samples from random unrelated donors were administered through colonoscopy at weeks 0, 2, 6, 10, 14, 18, and 22. The primary outcome was achievement of steroid-free clinical remission, and the secondary outcomes were clinical response and endoscopic remission at 24 weeks. Modified intention-to-treat analysis was performed, which included subjects who underwent at least 1 FMT.ResultsOf 345 patients with UC treated during the study period, 49 (14.2%) had steroid-dependent UC. Of these 49 patients, 41 underwent FMT: 33 completed 7 sessions over 22 weeks according to the protocol, and 8 discontinued treatment (non-response, 5; lost to follow-up, 2; and fear of adverse effects, 1). At week 24, steroid-free clinical remission was achieved in 19 out of 41 (46.3%) patients, whereas clinical response and endoscopic remission were achieved in 31 out of 41 (75.6%) and 26 out of 41 (63.4%) patients, respectively. All patients with clinical response were able to withdraw steroids. There were no serious adverse events necessitating discontinuation.ConclusionsA multisession FMT via the colonoscopic route is a promising therapeutic option for patients with steroid-dependent UC, as it can induce clinical remission and aid in steroid withdrawal.

Abstracts S1252intolerance to linaclotide (diarrhea) -1 stopped aft er 14 months without recurrent symptoms. -1 switched to 24 μg every other day. -1 switched 24 μg daily alternating with 24 μg bid. -1 patient was symptom free for 18 months and developed recurrent symptoms aft er stopping the medication. Aft er resumption, symptoms have resolved with 30 months of follow up. -2 patients who were started on 8 μg bid changed to 24 μg bid. -2 patients have maintained long-term relief by using it as on demand therapy. No signifi cant adverse events were observed. Introduction: Cyclic Vomiting Syndrome (CVS) in adults is underdiagnosed because it is not well recognized by physicians although it accounts for up to 20% of patients referred to a GI practice for evaluation of unexplained vomiting and abdominal pain. Goals of therapy are to induce remission while also addressing the predisposing "trigger" factors. Th e purposes of this study are to provide an analysis of the clinical profi le, treatment responses, and outcomes based on managing adult CVS at a GI motility center. Methods: Our adult CVS database identifi ed 18 patients, 10 female, of ages ranging from 22-60, who were initially diagnosed at our center, received treatment, and had long term follow up of 1 to 4 years by one of the authors. Results: Onset of symptoms ranged from 1-15 years prior to diagnosis (mean of 4). Th e mean number of yearly ER visits or hospitalizations was 5.8. Weight loss ranged from 5-50 pounds. Ten patients underwent a 4 hour standardized radionuclide gastric emptying test: 6 had rapid emptying and. Six major "triggers" were identifi ed (some patients having >1): anxiety in 17, post-traumatic stress disorder in 2, migraines in 5, chronic marijuana use in 5, poorly controlled diabetes in 5, and menses in 4. All patients were treated with tricyclic antidepressants. Amitriptyline was the fi rst choice, starting at 10mg at night, increasing by 10mg every 2-3 weeks until CVS improved. Two patients were switched to doxepin due to side eff ects; their max doses were 100mg and 200mg. At the same time the "trigger" factors were aggressively addressed. With this treatment strategy 4 patients (22%) were able to stop their CVS medications and have remained asymptomatic for over 1 year. In addition, 11 patients (61%) responded remarkably with a reduction in the mean number of annual ER visits or hospitalizations from 5.8 to 0.6 and were fully functional. Th ree patients (17%) reported ongoing, approximately monthly, episodes and had unresolved trigger factors and medication noncompliance. Conclusion

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