TY - JOUR
T1 - Inflammatory Bowel Disease Outcomes following Fecal Microbiota Transplantation for Recurrent C. difficile Infection
AU - Allegretti, Jessica R.
AU - Kelly, Colleen R.
AU - Grinspan, Ari
AU - Mullish, Benjamin H.
AU - Hurtado, Jonathan
AU - Carrellas, Madeline
AU - Marcus, Jenna
AU - Marchesi, Julian R.
AU - Mcdonald, Julie A.K.
AU - Gerardin, Ylaine
AU - Silverstein, Michael
AU - Pechlivanis, Alexandros
AU - Barker, Grace F.
AU - Miguens Blanco, Jesus
AU - Alexander, James L.
AU - Gallagher, Kate I.
AU - Pettee, Will
AU - Phelps, Emmalee
AU - Nemes, Sara
AU - Sagi, Sashidhar V.
AU - Bohm, Matthew
AU - Kassam, Zain
AU - Fischer, Monika
N1 - Publisher Copyright:
© 2020 Crohn's & Colitis Foundation. Published by Oxford University Press. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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- A ll 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.
AB - 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- A ll 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.
KW - Clostridioides difficile infection
KW - Crohn's disease
KW - butyrate
KW - fecal microbiota transplantation
KW - inflammatory bowel disease
KW - microbiome
KW - ulcerative colitis
UR - http://www.scopus.com/inward/record.url?scp=85101370071&partnerID=8YFLogxK
U2 - 10.1093/ibd/izaa283
DO - 10.1093/ibd/izaa283
M3 - Article
C2 - 33155639
AN - SCOPUS:85101370071
SN - 1078-0998
VL - 27
SP - 1371
EP - 1378
JO - Inflammatory Bowel Diseases
JF - Inflammatory Bowel Diseases
IS - 9
ER -