Role of Fecal Microbiota Transplantation in Patients with Steroid Dependant Ulcerative Colitis

Abstract

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

Hot topics on fecal microbiota transplantation for the treatment of inflammatory bowel disease

“…However, a report (73) described a patient with CD who had positive blood cultures for multidrug-sensitive Escherichia coli bacteremia after FMT. Moreover, Grewal et al (66) reported a patient with UC progression and toxic megacolon after FMT, who died of sepsis after surgery. Although not treated for UC, in March 2020, the FDA issued a safety warning 1 that two patients with CDI were infected with drug-resistant Escherichia coli as a result of FMT treatment, and one died due to bacteremia (74).…”