Multiple fresh fecal microbiota transplants induces and maintains clinical remission in Crohn’s disease complicated with inflammatory mass

Abstract

The ancient Chinese medical literature, as well as our prior clinical experience, suggests that fecal microbiota transplantation (FMT) could treat the inflammatory mass. We aimed to evaluate the efficacy and safety of multiple fresh FMTs for Crohn’s disease (CD) complicated with intraabdominal inflammatory mass. The "one-hour FMT protocol" was followed in all patients. Twenty-five patients were diagnosed with CD and related inflammatory mass by CT or MRI. All patients received the initial FMT followed by repeated FMTs every 3 months. The primary endpoint was clinical response (improvement and remission) and sustained clinical remission at 12 months. Secondary endpoints were improvement in size of phegmon/abscess based upon cross-sectional imaging and safety of FMT. 68.0% (17/25) and 52.0% (13/25) of patients achieved clinical response and clinical remission at 3 months post the initial FMT, respectively. The proportion of patients at 6 months, 12 months and 18 months achieving sustained clinical remission with sequential FMTs was 48.0% (12/25), 32.0% (8/25) and 22.7% (5/22), respectively. 9.5% (2/21) of patients achieved radiological healing and 71.4% (15/21) achieved radiological improvement. No severe adverse events related to FMT were observed. This pragmatic study suggested that sequential fresh FMTs might be a promising, safe and effective therapy to induce and maintain clinical remission in CD with intraabdominal inflammatory mass.

Efficacy of faecal microbiota transplantation in Crohn’s disease: a new target treatment?

“…The clinical efficacy of FMT reported in the present study was consistent with those reported in our previous studies (Cui et al ., ; He et al , ; Wang et al , ). In the multivariate analysis, long disease duration (> 5 years) and moderate or severe disease (HBI ≥ 8) were associated with poor response to FMT.…”

“…It was the first report of significant long‐term relief in abdominal pain in patients with CD following FMT (Cui et al ., ). In a subsequent study, we demonstrated that multiple fresh FMTs were effective in inducing and maintaining clinical remission in CD patients with intra‐abdominal inflammatory masses (He et al , ). A subsequent pilot study explored the timing for the second course of FMT in order to maintain the clinical response of the first FMT.…”

Faecal freezing preservation period influences colonization ability for faecal microbiota transplantation

“…A number of practical factors are known to affect the outcome of FMT, including fresh or frozen faeces (Jiang et al 2017), single or multiple challenging (He et al 2017), antibiotic therapy prior to FMT (Ishikawa et al 2017). Fresh FMT has some difficulties in preparing fresh material.…”

Review article: the gut microbiome in inflammatory bowel disease—avenues for microbial management

“…However, taken collectively, the data from the randomised control trials that have been published to date suggest that distal administration, frequent dosing and use of diverse faecal microbiota could all be factors that could influence a positive response in ulcerative colitis. Interestingly, a recent study of FMT in CD reported that frequent dosing was associated with increased efficacy . Future research should investigate the efficacy and safety of capsule‐delivered FMT in inflammatory bowel disease as this would be more suitable for frequent dosing and would simplify the design of placebo‐controlled trials, though dose limitation may become a factor …”