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FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON
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Grey’s Anatomy, November 2008
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Willingness to Undergo FMT in Patients with UC Kahn SA et al. Inflamm Bowel Dis 2013
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Adapted from Shanahan F et al. Gastroenterology 2014 C. Diff. Infection ≠ IBD C. diff.= Acute Infection IBD = Chronic Inflammation
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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
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Dysbiosis in IBD: Cause or Consequence of Inflammation
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Antibiotics for active UC Khan KJ et al. AJG 2011 Nine trials, 622 patients NNT = 7 (95% CI = 4 to 25)
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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
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Anderson JL et al. Aliment Pharmacol Ther 2012 FMT and IBD Management of IBD: 63% disease remission
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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
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Angelberger S et al. AJG 2013
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60 gr 250 ml 100 ml Feces Preparation and Transplantation Angelberger S et al. AJG 2013
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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 (16.7-25) Antibiotics (Metronidazol), n5 Probiotics, n4 Patient Characteristics Angelberger S et al. AJG 2013
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FMT design Angelberger S et al. AJG 2013
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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
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CRP course Angelberger S et al. AJG 2013
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Efficacy Angelberger S et al. AJG 2013
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Dynamic change in microbiome Angelberger S et al. AJG 2013
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