fmt in ibd walter reinisch department of medicine mcmaster university hamilton, on

FMT in IBD

Walter Reinisch

Department of Medicine

McMaster University

Hamilton, ON

Grey’s Anatomy, November 2008

Willingness to Undergo FMT in Patients with UC

Kahn SA et al. Inflamm Bowel Dis 2013

Adapted from Shanahan F et al. Gastroenterology 2014

C. Diff. Infection ≠ IBD

C. diff.=Acute Infection

IBD =Chronic Inflammation

Wei W et al. JCM 2014

Dysbiosis in IBD

HC = healthy controls, ACD = acute CD, RCD = CD in remission, AUC = acute UC, RUC = UC in remission

Dysbiosis in IBD:Cause or Consequence of Inflammation

Antibiotics for active UC

Khan KJ et al. AJG 2011

Nine trials, 622 patients NNT = 7 (95% CI = 4 to 25)

Kruis, W., et al. Gut 2004;

Relapse rate within 1 year

Per-Protocol-Analysis (N = 222)

36,4%

0%

20%

40%

60%

80%

100%

33,9%

Equivalence significant with p = 0,003

E. Coli Nissle MESALAZIN

Probiotics for Maintenance of

Remission in UC

Anderson JL et al. Aliment Pharmacol Ther 2012

FMT and IBD

Management of IBD: 63% disease remission

Heterogeneity among Studies

UC > CD; (some with C.diff infection)

Disease characteristics incomplete (duration, location, disease

activity, endoscopic picture, concomitant treatment)

Patient preparation (lavage, antibiotics, PPI)

Stool preparation (g/mL saline, volume instilled)

Route of administration (naso-gastric, -jejunal, colonoscopy,

enema)

Number of administration (single, multiple)

Donor relationship (relatives, unrelated, one or multiple donors)

Outcomes (subjective, score-based)

Duration of follow-up

Angelberger S et al. AJG 2013

60 gr

250 ml

100 ml

Feces Preparation and Transplantation

Angelberger S et al. AJG 2013

Patient (f/m) 5 (2/3)

Age year, median (range) 27 (22-51)

Age at diagnosis, year, median (range) 26 (18-47)

Extent, n

extensive 4

left-sided 1

Failure to

AZA 4

MTX 2

CsA 3

IFX 4

ADA 2

Median total Mayo Score (range), baseline 11 (8-11)

FMT via enema, gr (range) 20 (6-21.7)

FMT via tube, gr (range) 23.8 (16.7-25)

Antibiotics (Metronidazol), n 5

Probiotics, n 4

Patient Characteristics

Angelberger S et al. AJG 2013

FMT design

Angelberger S et al. AJG 2013

Safety

no SAE

no „bacterial overgrowth“ (glucose breath test wks 4 and 12)

AEs:

FMT, n Follow-up, n

Worsening of diarrhoe 5 Common cold 3

Fever* 5 Itchiness 1

Increase in CRP# 5 Erythema 1

Flatulence 1 Paresthesia (hip) 1

Vomiting 1 Collapse 1

Blister (tongue) 1

Angelberger S et al. AJG 2013

CRP course

Angelberger S et al. AJG 2013

Efficacy

Angelberger S et al. AJG 2013

Dynamic change in microbiome

Angelberger S et al. AJG 2013