Fecal microbiota transplants effective treatment for C. difficile, Inflammatory Bowel Disease
Growing evidence for the effectiveness of fecal microbiota transplants as a treatment for patients with recurrent bouts of Clostridium difficile (C.difficile) associated diarrhea is presented in three studies -- including a long-term follow-up of colonoscopic fecal microbiota transplant (FMT) for recurrent C. difficile Infection that included 77 patients from five different states-- unveiled today at the American College of Gastroenterology's (ACG) 76th Annual Scientific meeting in Washington, DC.
In a fourth study, investigators from the Centre for Digestive Diseases in Australia explored fecal bacterial transplantation as a treatment for Inflammatory Bowel Disease. While this is a new area of research, results of this study show success in treating IBD when the fecal transplant is done recurrently.
The first study, "Long-term Follow-up of Colonoscopic Fecal Microbiota Transplant (FMT) for Recurrent C. difficile Infection (RCDI)," included 77 patients from five different states (RI, NY, OK, CA,WA) who previously had a colonoscopic fecal microbiota transplant at least three months ago for recurrent C. difficile infection, and found that FMT was successful in 70 out of 77 patients (91 percent) who were on average elderly, debilitated and had undergone multiple failed treatments, including antibiotic and probiotic therapies. Additionally, in six of the remaining seven patients, a single two-week course of vancomycin or a two-week vancomycin course plus one further FMT resulted in cure (98 percent).
"Many of these patients we followed up with had been ill for a long time, but once they underwent the fecal microbiota transplant their response to the treatment was quick and their symptoms improved on average in about six days," said investigator Mark H. Mellow, MD, FACG, of INTERGRIS Baptist Medical Center in Oklahoma. The average duration of illness for these patients was 11 months, but after the procedure patients continued to improve and --without subsequent antibiotic treatment--did not have a recurrence of C. difficile infection during follow-up (on average , 17 months), according to Dr. Mellow and his team of co-investigators which included a leading pioneer of fecal microbiota transplantation, Lawrence J. Brandt, MD, MACG, of the Albert Einstein College of Medicine in New York.
Results from a meta-analysis by researchers at the University of Toledo Medical Center were also unveiled today, providing further evidence of the effectiveness of fecal microbiota transplantation.
"Fecal Bacteriotherapy Works for Clostridium difficile Infection A Meta-Analysis," reviewed the cases of 148 patients who had received fecal transplants for C. difficile infection. Follow-up ranged from 10 days to 62 months after the transplant, with an average follow-up of 1 year. Fecal transplant had an overall success rate of 85.4 percent, according to researchers, who also concluded that the procedure was a safe and effective treatment option for C. difficile infection.
Clostridium difficile is a bacterium that causes infection leading to diarrhea and is most often related to antibiotic use during medical treatment. A major cause of morbidity and increasing health care costs among hospitalized patients, C. difficile infections have dramatically increased in recent years, with 500,000 cases in the United States annually and approximately 15,000 deaths each year, according to the U.S. Centers for Disease Control & Prevention. Up to 25 percent of patients will have a recurrence of C. difficile infection, and a proportion will be refractory to antibiotics. C. difficile is especially dangerous for patients with weakened immune systems such as the elderly and those with Inflammatory Bowel Disease (IBD). Therapies for this difficult to treat subpopulation include antibiotics, probiotics, toxin-binding medications, active vaccination, intravenous immunoglobon, and fecal microbiota transplant, for which the evidence has been mounting as an effective rescue for recurrent and refractory cases of C. difficile associated diarrhea.
"While the concept of fecal transplantation may sound unpleasant to some, patient acceptance of this treatment is growing, especially when they have been suffering for months with recurrent C. difficile," said Dr. Mellow. "When we asked patients in our study about their choice of treatment if their infection recurred, 53 percent said fecal transplant would be their first choice for treatment."
In a related study also unveiled today, "Clostridium Difficile Infection in Ulcerative Colitis: Increased Risk of Colectomy and Postoperative Infectious Complications," researchers from the University of Calgary found that patients with ulcerative colitis who were diagnosed with C. difficile were significantly less likely to respond to medical treatment and as a result require a colectomy when they diagnosed with C. difficile in the hospital or within 90 days of admission. In addition, patients with ulcerative colitis who had concomitant C. difficile, preoperatively were at a higher risk of infectious complications following a colectomy.
Researchers Find Fecal Microbiota Transplantation Effective For Treatment of IBD
With the growing success of fecal transplantation for C.Difficile, researchers have started to explore the effectiveness of this procedure for other serious conditions, such as Inflammatory Bowel Disease (IBD). A second study, "Reversal of Inflammatory Bowel Disease (IBD) with Recurrent Fecal Microbiota Transplants (FMT)," reports successful treatment of severe mixed IBD using recurrent fecal microbiota transplants in three patient cases.
In Case 1, a 19-year old female with an 11-year history of severe IBD and who presented with worsening symptoms including bloody diarrhea and inflamed, ulcerated mucosa , and was considering a colectomy, experienced symptom improvement within several days after receiving FMT. She underwent FMT initially via colonoscopy in July 2009 then by seven daily rectal FMT and 26 weekly FMT's. Follow-up colonoscopy revealed no gross inflammation or edema, with the patient remaining clinically well.
In Case 2, a 23- year old male with a five-year history of steroid and anti-TNFα refractory ulcerative colitis presented with bloody diarrhea more than 20 times per day, anal fissures, severe abdominal pain and joint pain. Pre-FMT colonoscopy showed severe disease of the left colon with marked cecal inflammation. He underwent daily rectal FMT for the first month, followed by infusions of lessening frequency until he reached 1 FMT/6 weeks. He reported resolution of bleeding 1-2 weeks post-FMT, and formed stool at 1 month post-FMT, resumed work, study activities and regained weight. Colonoscopy at one year showed no histological inflammation but occasional pseudopolyps in the cecum and ascending colon.
In Case 3, a 57-year old female with a nine- year history of 5-ASA antibiotics, probiotics and immunosuppressant refractory ulcerative proctitis in spite of treatment. After training in our clinic, she performed 69, initially daily, then weekly rectal FMT with virtually immediate resolution of diarrhea, bleeding and mucus. Follow-up colonoscopy showed no visible or histological inflammation and she has remained off all therapy for the last four years.
FMT may act as an antagonist to etiological infective agent(s) and aid in re-establishing depleted bacterial species, thereby reversing IBD, according to researchers from the Centre for Digestive Diseases in Australia.
Commenting on the cases of FMT in IBD, lead researcher Thomas Borody, MD, PhD, FACG, said, "the rapid response of FMT and lack of adverse effects make FMT a viable option for treatment-refractory patients and is certainly an added option for those facing colectomy."
Provided by American College of Gastroenterology
- Patients with bowel disease eager to test 'fecal' therapy Jun 02, 2011 | not rated yet | 0
- Study hints at probiotics as treatment for Clostridium difficile Apr 20, 2011 | not rated yet | 0
- C. difficile increases risk of death 6-fold in patients with inflammatory bowel disease Apr 20, 2011 | not rated yet | 0
- Attack on C. difficile: How can we combat this serious health issue Oct 18, 2010 | not rated yet | 0
- C. difficile and antibiotics not necessarily linked Oct 07, 2008 | not rated yet | 0
- Motion perception revisited: High Phi effect challenges established motion perception assumptions Apr 23, 2013 | 3 / 5 (2) | 2
- Anything you can do I can do better: Neuromolecular foundations of the superiority illusion (Update) Apr 02, 2013 | 4.5 / 5 (11) | 5
- The visual system as economist: Neural resource allocation in visual adaptation Mar 30, 2013 | 5 / 5 (2) | 9
- Separate lives: Neuronal and organismal lifespans decoupled Mar 27, 2013 | 4.9 / 5 (8) | 0
- Sizing things up: The evolutionary neurobiology of scale invariance Feb 28, 2013 | 4.8 / 5 (10) | 14
Rotating electron as a dipole is this right?
2 hours ago An electron as shown by the Stern Gerlach experiment behaves like a dipole (albeit only in one of two states). I have been trying to figure out how...
Dipole term in multipole expansion
6 hours ago Hi. I'm having some difficult in understanding something about the dipole term in a multipole expansion. Griffiths writes the expansion as a sum of...
Bubbles in a Pre-Boiling/Boiling pot of water
8 hours ago How is it that bubbles form on the bottom of a surface of a pot of boiling water? I think that there is probably an elementary answer to this...
Assumptions of Griffith's fracture theory
18 hours ago Any experts on Griffith's fracture theory? I am studying the subject and I am having hard time finding out if the theory is valid for all possible...
Current leading voltage or vice versa concept
20 hours ago Hello, I was wondering if there is a conceptual explanation for when current leads voltage or vice versa for capacitors or inductors with AC...
Angular Frequency of AC voltage
23 hours ago Hello, I am wondering, what is the physical interpretation of the angular frequency of AC voltage? I don't see the physicality of what the angle...
- More from Physics Forums - Classical Physics
More news stories
The negative effects of poorly controlled asthma symptoms on sleep quality and academic performance in urban schoolchildren has been confirmed in a new study.
Inflammatory disorders 12 hours ago | not rated yet | 0
Patients with inflammatory bowel disease (IBD) are at higher risk of melanoma, a form of skin cancer, report researchers at Mayo Clinic. Researchers found that IBD is associated with a 37 percent greater risk for the disease. ...
Inflammatory disorders May 20, 2013 | 4 / 5 (1) | 0
(Medical Xpress)—Inflammation is an important response in the body - it helps you to kill off invaders such bacteria that could cause a harmful infection. But if it's chronic or uncontrolled, inflammation can also cause ...
Inflammatory disorders May 14, 2013 | not rated yet | 0 |
New research by medical students working in the Breathe Well Centre of Research Excellence at the UTAS School of Medicine has revealed swimming has health benefits for young people with asthma, with no adverse effects on ...
Inflammatory disorders May 10, 2013 | not rated yet | 0
An estimated 4,837,000 asthmatics with allergic bronchopulmonary aspergillosis (ABPA) could benefit substantially from antifungal treatment, say researchers from The University of Manchester and the University of Toronto.
Inflammatory disorders May 08, 2013 | not rated yet | 0
(Medical Xpress)—Native peoples in regions where cameras are uncommon sometimes react with caution when their picture is taken. The fear that something must have been stolen from them to create the photo ...
10 hours ago | 4 / 5 (4) | 0 |
(Medical Xpress)—Despite spending billions of dollars on research and development, drug companies have been unable to come up with effective treatments for dementia and Alzheimer's Disease (AD). Now, A. ...
8 hours ago | 4.8 / 5 (6) | 0 |
An experimental sleeping pill from US drug company Merck is effective at helping people fall and stay asleep, according to reviewers at the US Food and Drug Administration, which could soon approve the new drug.
3 hours ago | 5 / 5 (1) | 0
Activating an enzyme known to play a role in the anti-aging benefits of calorie restriction delays the loss of brain cells and preserves cognitive function in mice, according to a study published in the May ...
4 hours ago | 5 / 5 (3) | 0 |
A drug commonly used to treat depression and anxiety may improve a stress-related heart condition in people with stable coronary heart disease, according to researchers at Duke Medicine.
5 hours ago | not rated yet | 0 |
Australian scientists have charted the path of insulin action in cells in precise detail like never before. This provides a comprehensive blueprint for understanding what goes wrong in diabetes.
9 hours ago | 4.8 / 5 (4) | 0 |