Profound Remission in Inflammatory Bowel Disease Following Antibiotics Then Fecal Microbiota Transplantation: A Retrospective Study

Abstract

Introduction: Chronic Inflammatory Bowel Disease (IBD) affects the gastrointestinal tract with exacerbation of symptoms, followed by periods of remission. While the etiology and pathogenesis of IBD remains unknown, they are thought to involve an interaction between the host, genetics and environmental factors, modulated via the gut microbiome. There is currently no cure, with treatment relying on immunosuppression and symptom management. Emerging evidence suggests Fecal Microbiota Transplantation (FMT) treatment can occasionally induce clinical remission for prolonged periods. We report on the outcomes of patients with IBD treated with antibiotics, followed by FMT. Methods: A retrospective analysis of records was conducted on patients with IBD, treated with antibiotics followed by FMT and who had completed a follow up colonoscopy post-FMT. Primary outcomes included clinical remission: normal bowel function and degree of histological remission: normal colonoscopy and histology. Secondary outcome measures were: need for ongoing IBD therapy and improvements in inflammatory markers: C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Patient records were systematically examined at three time points; first colonoscopy, first FMT infusion and most recent colonoscopy. A paired t-test for continuous variables and McNemar's test for dichotomous variables were used to assess the outcomes pre and post treatment. Results: A total of 50 patients (age=38±12yrs, 26 M) underwent serial antibiotic and FMT treatment between 2001 and 2018 (Table 1). At baseline most patients had active disease (N=46, 92%) and reported symptoms of diarrhoea (N=37, 74%) and blood in the stool (N=32, 64%). At follow up (3±3yrs Post initial FMT); 37 (74%) patients were in clinical remission with 19 (38%) having no visible active disease on colonoscopy (p<0.001) and 18 (36%) having only mild inflammation on colonoscopy. Histology was normalised in 13 (26%) patients and 6 (12%) were able to cease all therapies for IBD. There was a significant decrease in bowel motion frequency (p=0.003) and ESR (p=0.03). Conclusion: 1. Patients with IBD treated with antibiotics then FMT can achieve clinical and histological remission when re-studied at 3 or more years after treatment. 2. Most significantly 12% achieved profound remission and remain off IBD therapies for prolonged periods.2819 Figure 1 No Caption available.