P489 Faecal microbiota transplantation via nasogastric route for the treatment of recurrent and antibiotic refractory Clostridum Difficile infection: The UK experience
M.N. Quraishi*1, V. McCune2, T.H. Iqbal1, S. Pathmakanthan1, J.K. Struthers2, E. Moran2, M. Widlak1, N. Sharma2, P.M. Hawkey2
1University Hospitals Birmingham NHS Foundation Trust, Department of Gastroenterology, Birmingham, United Kingdom, 2Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham, United Kingdom
Faecal microbiota transplantation (FMT) has been shown to be a highly effective and safe treatment strategy for recurrent and antibiotic refractory Clostridium Difficile infection (CDI). This procedure has mainly been reported to be carried out in the United States, Canada and several European countries however experience using the nasogastric (NG) route is as yet limited. Nasogastric / nasoduodenal administration has been shown to be a safe and effective mode of administration of FMT and was the route for delivery in the only RCT that demonstrated its efficacy for recurrent CDI. We present our clinical experience using this mode of treatment in patients who underwent FMT for CDI via a NG tube over a one year period.
Patients underwent FMT for CDI at the University Hospital Birmingham and Heart of England Foundation Trust from March 2013 to September 2014. Donors were selected from a cohort of screened volunteers and processed stool was administered via the nasogastric route to patients who had either recurrent or antibiotic refractory CDI. Demographic data, antibiotic treatment, biochemical markers, stool frequency and type were collected for each patient. CDI cure was defined as less than 3 unformed bowel movements (Bristol Stool Chart type 1 - 5) per day for 2 consecutive days.
A total of 23 patients underwent FMT of which 11 were for antibiotic refractory CDI and 12 for recurrent CDI. Twenty one patients (91%) achieved a CDI cure rate after a single FMT. Of the 16 patients with a 12 week follow up period 14 patients (88%) suffered no recurrence of CDI post FMT. One patient who relapsed following an initial response to FMT had a second FMT with a further response prior to relapsing before 90 days. Three patients died within 90 days of the FMT with one as a result of refractory CDI that failed to respond to FMT, however there were no deaths directly associated with FMT. The main side effect reported was constipation in three patients and abdominal discomfort in one patient.
In the largest UK series to date we have demonstrated that FMT administered via nasogastric route is a highly effective, safe and tolerable therapy for recurrent and antibiotic refractory CDI. The manipulation of gut microbiota represents a promising new therapeutic option that warrants further investigation in the treatment of gastrointestinal disease. Our data, in conjunction with recent safety/acceptability information of orally delivered capsules for FMT reinforces the possibility of either the nasogastric or even oral route of delivery for treatment. Either of these is, of course, much easier than nasoduodenal or colonic delivery.