FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.

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Presentation transcript:

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 NissleM ESALAZIN 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 extensive4 left-sided1 Failure to AZA4 MTX2 CsA3 IFX4 ADA2 Median total Mayo Score (range), baseline11 (8-11) FMT via enema, gr (range)20 (6-21.7) FMT via tube, gr (range)23.8 ( ) Antibiotics (Metronidazol), n5 Probiotics, n4 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, nFollow-up, n Worsening of diarrhoe5Common cold3 Fever*5Itchiness1 Increase in CRP # 5Erythema1 Flatulence1Paresthesia (hip)1 Vomiting1Collapse1 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