P333 Safety of fecal microbiota transplantation in patients with chronic colitis and immunosuppressive treatement.
J. Frank*1, C. Högenauer1, H.-P. Gröchenig2, K.M. Hoffmann3, G. Reicht4, H.H. Wenzl1, W. Petritsch1, P.K. Kump1
1Medical University of Graz, Internal Medicine, Division of Gastroenterology and Hepatology, Graz, Austria, 2Barmherzige Brüder Hospital, Internal Medicine, St. Veit an der Glan, Austria, 3Medical University of Graz, Pediatrics, Graz, Austria, 4Barmherzige Brüder Hospital, Internal Medicine, Graz, Austria
Alterations of the gut microbiome, termed dysbiosis, are postulated in patients with recurrent Clostridium difficile colitis (CDI) as well as inflammatory bowel diseases as ulcerative colitis (UC). In these diseases fecal microbiota transplantation (FMT) is supposed to reestablish a normal microbiota. The aim of the present study was to investigate short- and long-term side effects and safety of FMT.
Between 02/2011 and 06/2014 30 patients received FMT due to various indications such as UC (n= 21), CDI (n=7) and cryptogenic or antibiotic associated colitis (n=2). All patients were nonresponsive to standard medical therapy. 22/30 of our patients received one (n=13) or more (n=9) immunosuppressive drugs due to their underlying diseases at the time of FMT. Short-term side effects and laboratory parameters were compiled during the observation period of 90 days in UC patients and 3 days in the non UC patients. Long-term safety data referring to de novo occurred diseases or persisting symptoms after FMT were collected via questionnaire.
13/30 patients showed elevated CRP values one day after FMT: before FMT 9,31 mg/l (0,6 - 82,6mg/l), after FMT 15,9 mg/l (0,6 - 103,1 mg/l). There was no correlation between CRP increase and immunosuppressive therapy. Minor adverse events like temperature increase (n=3) up to 38,1 °C, abdominal pain (n=5) and flatulence (n=3) were described up to 7 days after FMT. During the long term observation period intermittently gluten sensitivity (n=1), joint pain (n=1) and post-infectious irritable bowel syndrome (n=1) occured. 2 UC patients, Non-Responders to FMT, developed a colonic stenosis in chronic active disease with the consequence of colectomy 18 month after FMT, one of them appeared with an histological verified low grade DALM. 1 patient presented with a benign thyroid nodule, another one developed a multilevel thrombosis within 12 month after FMT.
Colonoscopically applied FMT is well tolerated and shows high safety despite ongoing immunosuppressive therapy. There were no immediate severe adverse events observed. A temporary increase of CRP levels after FMT was noticed without any need of therapeutic intervention. The development of intestinal stenosis and DALM is a known complication in chronic active UC patients, the role of FMT as an additional risk factor has to be further investigated.