Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

BACKGROUND The pathogenesis of gastroesophageal reflux disease(GERD)is closely associated with the intestinal bacteria composition and their metabolites.AIM To investigate whether washed microbiota transplantation(WMT)improves symptoms of nonerosive reflux disease(NERD)with proton pump inhibitor(PPI)dependency.METHODS Patients with recurrent NERD and PPI dependency at the First Affiliated Hospital of Guangdong Pharmaceutical University from 2017 to 2018 were included and divided into a WMT or PPI group treated with PPI with/without WMT.The endpoint was NERD symptom frequency evaluated 1 mo after WMT using reflux disease questionnaire(RDQ)and GERD questionnaire(GERDQ)scores,remission time,PPI dose,and the examination of intestinal mucosal barrier function.RESULTS In the WMT(n=15)and PPI(n=12)groups,the total remission rate at 1 mo after treatment was 93.3%vs 41.7%.Compared with the PPI group,the WMT group showed better results in GERDQ(P=0.004)and RDQ(P=0.003)and in remission months(8 vs 2,P=0.002).The PPI dose was reduced to some extent for 80%of patients in the WMT group and 33.3%in the PPI group.In 24 patients,intestinal mucosal barrier function was examined before treatment,and changes in the degree of damage were observed in 13 of these patients after treatment.Only one of the 15 patients had minor side effects,including a mushy stool two or three times a day,which resolved on their own after 1 wk.CONCLUSION This study is the first to demonstrate that WMT may be safe and effective for relieving NERD symptoms and reducing PPI dependency and recurrence.

Efficacy and Safety of Washed Microbiota Transplantation to Treat Patients with Mild-to-Severe COVID-19 and Suspected of Having Gut Microbiota Dysbiosis: Study Protocol for a Randomized Controlled Trial

Objective:Coronavirus disease 2019(COVTD-19)is often accompanied by gastrointestinal symptoms,which are related to gut microbiota dysbiosis(GMD).Whether washed microbiota transplantation(WMT)is an effective treatment for COV1D-19 patients suspected of having GMD by restoring the gut microbiota is unknown.This study is designed to explore the efficacy and safety of WMT in COVID-19 patients suspected of having GMD.Methods:This is a randomized,multicenter,single-blind prospective study.COVID-19 patients suspected of having GMD will be randomly divided to receive routine treatment only or to receive routine treatment and WMT.The frequency of WMT will be once a day for three consecutive days.Laboratory and imaging examinations will be performed at admission,1 and 2 weeks after treatment,and on the day of discharge.Then a telephone follow-up will be conducted at 1st week,2nd week,and 6th month after discharge.The clinical efficacy and safety of WMT in COVD-19 patients suspected of having GMD and the effects of WMT on the organ function,homeostasis,inflammatory response,intestinal mucosal barrier function,and immunity of the patients will be evaluated.Results:By following the proposed protocol,WMT is expected to be efficacious and safe for the treatment of COVID-19 patients suspected of having GMD,and the therapeutic effect is expected to be associated with improvement of the intestinal mucosal barrier function,inflammatory response,and immunity.Conclusion:The findings from this study may offer a new approach for the prevention and treatment of COVID-19 patients suspected of having GMD.

Washed microbiota transplantation reduces serum uric acid levels in patients with hyperuricaemia

BACKGROUND Previous studies have found that hyperuricaemia(HUA)is closely related to intestinal flora imbalance.AIM The current study investigated the effects and safety of washed microbiota transplantation(WMT)on serum uric acid(SUA)levels in different populations.METHODS A total of 144 patients who received WMT from July 2016 to April 2020 in the First Affiliated Hospital of Guangdong Pharmaceutical University and had SUA data before treatment were selected.Changes in SUA levels before and after treatment were retrospectively reviewed based on short-term and mid-term effects of WMT regimens.SUA levels measured in the last test within 3 mo after the first WMT represented the short-term effect,and SUA levels measured in the last test within 3-6 mo after the first WMT represented the mid-term effect.The patients were divided into an HUA group(SUA>416μM)and a normal uric acid(NUA)group(SUA≥202μM to≤416μM)based on pretreatment SUA levels.RESULTS Average short-term SUA levels in the HUA group decreased after WMT(481.00±99.85 vs 546.81±109.64μM,n=32,P<0.05)in 25/32 patients and returned to normal in 10/32 patients.The shortterm level of SUA reduction after treatment moderately correlated with SUA levels before treatment(r=0.549,R²=0.300,P<0.05).Average SUA levels decreased after the first and second courses of WMT(469.74±97.68 vs 540.00±107.16μM,n=35,and 465.57±88.88 vs 513.19±78.14μM,n=21,P<0.05).Short-term and mid-term SUA levels after WMT and SUA levels after the first,second and third courses of WMT were similar to the levels before WMT in the NUA group(P>0.05).Only 1/144 patients developed mild diarrhea after WMT.CONCLUSION WMT reduces short-term SUA levels in patients with HUA with mild side effects but has no obvious effect on SUA levels in patients with NUA.

Awareness and attitude of fecal microbiota transplantation through transendoscopic enteral tubing among inflammatory bowel disease patients

BACKGROUND Transendoscopic enteral tubing(TET)has been used in China as a novel delivery route for fecal microbiota transplantation(FMT)into the whole colon with a high degree of patient satisfaction among adults.AIM To explore the recognition and attitudes of FMT through TET in patients with inflammatory bowel disease(IBD).METHODS An anonymous questionnaire,evaluating their awareness and attitudes toward FMT and TET was distributed among IBD patients in two provinces of Eastern and Southwestern China.Question formats included single-choice questions,multiple-choice questions and sorting questions.Patients who had not undergone FMT were mainly investigated for their cognition and acceptance of FMT and TET.Patients who had experience of FMT,the way they underwent FMT and acceptance of TET were the main interest.Then all the patients were asked whether they would recommend FMT and TET.This study also analyzed the preference of FMT delivery in IBD patients and the patient-related factors associated with it.RESULTS A total of 620 eligible questionnaires were included in the analysis.The survey showed that 44.6%(228/511)of patients did not know that FMT is a therapeutic option in IBD,and 80.6%(412/511)of them did not know the concept of TET.More than half(63.2%,323/511)of the participants stated that they would agree to undergo FMT through TET.Of the patients who underwent FMT via TET[62.4%(68/109)],the majority[95.6%(65/68)]of them were satisfied with TET.Patients who had undergone FMT and TET were more likely to recommend FMT than patients who had not(94.5%vs 86.3%,P=0.018 and 98.5%vs 87.8%,P=0.017).Patients’choice for the delivery way of FMT would be affected by the type of disease and whether the patient had the experience of FMT.When compared to patients without experience of FMT,Crohn’s disease and ulcerative colitis patients who had experience of FMT preferred mid-gut TET(P<0.001)and colonic TET(P<0.001),respectively.CONCLUSION Patients’experience of FMT through TET lead them to maintain a positive attitude towards FMT.The present findings highlighted the significance of patient education on FMT and TET.

Radiation injury and gut microbiota-based treatment

The exposure to either medical sources or accidental radiation can cause varying degrees of radiation injury(RI).RI is a common disease involving multiple human body parts and organs,yet effective treatments are currently limited.Accumulating evidence suggests gut microbiota are closely associated with the development and prevention of various RI.This article summarizes 10 common types of RI and their possible mechanisms.It also highlights the changes and potential microbiota-based treatments for RI,including probiotics,metabolites,and microbiota transplantation.Additionally,a 5P-Framework is proposed to provide a comprehensive strategy for managing RI.

Encyclopedia of fecal microbiota transplantation: a review of effectiveness in the treatment of 85 diseases

Fecal microbiota transplantation(FMT)has been used as a core therapy for treating dysbiosis-related diseases by remodeling gut microbiota.The methodology and technology for improving FMT are stepping forward,mainly including washed microbiota transplantation(WMT),colonic transendoscopic enteral tubing(TET)for microbiota delivery,and purified Firmicutes spores from fecal matter.To improve the understanding of the clinical applications of FMT,we performed a systematic literature review on FMT published from 2011 to 2021.Here,we provided an overview of the reported clinical benefits of FMT,the methodology of processing FMT,the strategy of using FMT,and the regulations on FMT from a global perspective.A total of 782 studies were included for the final analysis.The present review profiled the effectiveness from all clinical FMT uses in 85 specific diseases as eight categories,including infections,gut diseases,microbiotagut-liver axis,microbiotagut-brain axis,metabolic diseases,oncology,hematological diseases,and other diseases.Although many further controlled trials will be needed,the dramatic increasing reports have shown the promising future of FMT for dysbiosis-related diseases in the gut or beyond the gut.

Impact of cap-assisted colonoscopy during transendoscopic enteral tubing:A randomized controlled trial

BACKGROUND Colonic transendoscopic enteral tubing(TET)requires double cecal intubation,raising a common concern of how to save cecal intubation time and make the tube stable.We hypothesized that cap-assisted colonoscopy(CC)might reduce the second cecal intubation time and bring potential benefits during the TET procedure.AIM To investigate if CC can decrease the second cecal intubation time compared with regular colonoscopy(RC).METHODS This prospective multicenter,randomized controlled trial was performed at four centers.Subjects≥7 years needing colonic TET were recruited from August 2018 to January 2020.All subjects were randomly assigned to two groups.The primary outcome was the second cecal intubation time.Secondary outcomes included success rate,insertion pain score,single clip fixation time,purpose and retention time of TET tube,length of TET tube inserted into the colon,and all procedurerelated(serious)adverse events.RESULTS A total of 331 subjects were randomized to the RC(n=165)or CC(n=166)group.The median time of the second cecal intubation was significantly shorter for CC than RC(2.2 min vs 2.8 min,P<0.001).In patients with constipation,the median time of second cecal intubation in the CC group(n=50)was shorter than that in the RC group(n=43)(2.6 min vs 3.8 min,P=0.004).However,no difference was observed in the CC(n=42)and RC(n=46)groups of ulcerative colitis patients(2.0 min vs 2.5 min,P=0.152).The insertion pain score during the procedure in CC(n=14)was lower than that in RC(n=19)in unsedated colonoscopy(3.8±1.7 vs 5.4±1.9;P=0.015).Multivariate analysis revealed that only CC(odds ratio[OR]:2.250,95%confidence interval[CI]:1.161-4.360;P=0.016)was an independent factor affecting the second cecal intubation time in difficult colonoscopy.CC did not affect the colonic TET tube’s retention time and length of the tube inserted into the colon.Moreover,multivariate analysis found that only endoscopic clip number(OR:2.201,95%CI:1.541-3.143;P<0.001)was an independent factor affecting the retention time.Multiple regression analysis showed that height(OR:1.144,95%CI:1.027-1.275;P=0.014)was the only independent factor influencing the length of TET tube inserted into the colon in adults.CONCLUSION CC for colonic TET procedure is a safe and less painful technique,which can reduce cecal intubation time.