Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(...Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.展开更多
文摘Background:Clostridium difficile infection(CDI)in patients with ileal pouch-anal anastomosis(IPAA)has been increasingly recognized.The aim of this study was to evaluate the outcome of fecal microbiota transplantation(FMT)in patients with pouch and CDI.Methods:All consecutive patients that underwent FMT for CDI from 2012 to 2016 were extracted from our IRB-approved,prospectively maintained Registry of Pouch Disorders.The primary outcome was negative stool tests for Clostridium difficile after FMT and the secondary outcomes were symptomatic and endoscopic responses.Results:A total of 13 patients were included in this study,with 10 being Caucasian males(76.9%).All patients had underlying ulcerative colitis for J pouch surgery.After a mean of 2.8±0.8 courses of antibiotic treatments was given and failed,22 sessions of FMT were administered with an average of 1.7±1.1 sessions each.Within the 22 sessions,16 were given via pouchoscopy,4 via esophagogastroduodenoscopy and 2 via enemas.All patients tested negative on C.difficile polymerase chain reaction(PCR)after the initial FMT with a total of 7/12(58.3%)documented patients showed symptomatic improvements and 3/11(27.3%)patients showed endoscopic improvement according to the modified Pouchitis Disease Activity Index.During the follow-up of 1.2±1.1 years,there were a total of five patients(38.5%)that had recurrence after the successful initial treatment and four of them were successfully treated again with FMT.Conclusions:FMT appeared to be effective in eradication of CDI in patients with ileal pouches.However,FMT had a modest impact on endoscopic inflammation and recurrence after FMT and recurrence was common.
