Inflammatory Bowel Disease Outcomes following Fecal Microbiota Transplantation for Recurrent C. difficile Infection

Jessica R. Allegretti, Colleen R. Kelly, Ari Grinspan, Benjamin H. Mullish, Jonathan Hurtado, Madeline Carrellas, Jenna Marcus, Julian R. Marchesi, Julie A.K. Mcdonald, Ylaine Gerardin, Michael Silverstein, Alexandros Pechlivanis, Grace F. Barker, Jesus Miguens Blanco, James L. Alexander, Kate I. Gallagher, Will Pettee, Emmalee Phelps, Sara Nemes, Sashidhar V. SagiMatthew Bohm, Zain Kassam, Monika Fischer

Research output: Contribution to journalArticlepeer-review

17 Scopus citations

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- 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.

Original languageEnglish
Pages (from-to)1371-1378
Number of pages8
JournalInflammatory Bowel Diseases
Volume27
Issue number9
DOIs
StatePublished - 1 Sep 2021

Keywords

  • Clostridioides difficile infection
  • Crohn's disease
  • butyrate
  • fecal microbiota transplantation
  • inflammatory bowel disease
  • microbiome
  • ulcerative colitis

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