P591. A prospective controlled pilot study of faecal microbiota transplantation for chronic refractory pouchitis
J. Landy1, H. Omar Al-Hassi2, E. Ronde2, E. Mann2, S. Peake1, S. McLaughlin3, Z.L. Perry-Woodford4, P.J. Ciclitira5, R.J. Nicholls6, S.K. Clark7, S. Knight2, A.L. Hart1, 1St Mark's Hospital, IBD Unit, London, United Kingdom, 2Antigen Presentation Research Group, Imperial College, London, United Kingdom, 3Royal Bournemouth and Christchurch NHS Hospitals Trust, Gastroenterology, Bournemouth, United Kingdom, 4St Mark's Hospital, London, United Kingdom, 5St Thomas' Hospital, Gastroenterology, London, United Kingdom, 6Imperial College, Department of Biosurgery and Surgical Technology, London, United Kingdom, 7St Mark's Hospital, Colorectal Surgery, London, United Kingdom
Faecal microbiota transplantation (FMT) is an effective therapy for Clostridium difficile and possibly inflammatory bowel diseases (IBD). Published data of FMT for inflammatory bowel diseases are reported in case series and case reports. To our knowledge, there are no controlled studies of FMT for IBD. We aimed to conduct a prospective study of FMT for chronic refractory pouchitis.
Patients with clinically, endoscopically and histologically confirmed chronic refractory pouchitis; with a pouch disease activity index (PDAI >7) were included. Donors were nominated by the participating patients and were screened by clinical history and serology for HAV, HBV, HCV, HEV, Treponema, HIV, HTLV I/II and stool for M, C+S, C. difficile toxin and parasites. Thirty grams of fresh donor stool was collected and homogenised with 50 ml of sterile saline within six hours of nasogasric administration of FMT. Stool samples were also collected from patients for analysis of coliform sensitivities before and 4 weeks after FMT. PDAI and Cleveland global quality of life score (CGQoL) were recorded prior to FMT and four weeks after FMT.
Eight patients with chronic refractory pouchitis who had undergone restorative proctocolectomy for ulcerative colitis underwent FMT. Three patients had ESBL resistant coliforms on stool analysis prior to FMT. Two of these patients demonstrated a change to ciprofloxacin sensitive coliform following FMT. The mean PDAI prior to FMT was 12. The mean CGQoL was 0.45. At 4 weeks following FMT, no patient had achieved a clinical remission (mean PDAI 11). No improvement in CGQoL was seen (mean 0.44).
FMT via nasogastric administration was not effective in achieving clinical remission for chronic refractory pouchitis with no change in PDAI or CGQoL identified at 4 weeks after FMT. However, in two patients with ESBL resistant coliform, ciprofloxacin sensitivity was regained following FMT and these patients have subsequently been maintained on ciprofloxacin. This suggests FMT may alter the pouch microbiota. Further molecular microbiological analysis is being undertaken to determine the effect FMT had on these patients' microbiota. In addition, further studies of FMT are required to assess the effect of different methods of FMT that may be more efficacious for this group of patients.