Faecal microbiota transplantation as a treatment for inflammatory bowel disease: a national survey of adult and paediatric gastroenterologists in the UK

BackgroundInterest in the use of faecal microbiota transplantation (FMT) in inflammatory bowel disease (IBD) has increased following outcomes in patients with Clostridioides difficile infection (CDI). While research exploring clinician awareness and attitude towards the use of FMT in CDI has been carried out, data for IBD are currently lacking.ObjectiveTo assess the perceptions of gastroenterologists and current practice relating to FMT as a treatment for IBD in the UK.DesignA web-based survey (Snap Survey software) was distributed through the British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition e-newsletters, and at the BSG Conference in June 2017.Results61 respondents completed the survey including presubspecialty trainees, gastroenterology specialists, associate specialists and consultants. Most (95%; n=58) respondents stated that they had heard of FMT being used as a treatment for IBD prior to participating in the survey. Based on current evidence, 34% (n=21) of respondents would consider using FMT in patients with IBD, 26% (n=16) would not and 39% (n=24) were undecided. When asked to rank routes of delivery in terms of preference, nasogastric tube was the least preferred route (39%; n=24) and oral capsule was the most preferred route (34%; n=21).ConclusionsA clear majority of UK gastroenterologists recognise FMT as a potential treatment for IBD; however, uptake is limited. A proportion of clinicians would consider FMT in IBD and the majority would consider entering patients into clinical trials. Future work should explore the utility and efficacy of oral FMT capsules in IBD.

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Gaps in knowledge and future directions for the use of faecal microbiota transplant in the treatment of inflammatory bowel disease

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284819891038 ◽

2019 ◽

Vol 12 ◽

pp. 175628481989103 ◽

Cited By ~ 4

Author(s):

Mehmet Yalchin ◽

Jonathan P. Segal ◽

Benjamin H. Mullish ◽

Mohammed Nabil Quraishi ◽

Tariq H. Iqbal ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Early Stage ◽

Current Evidence ◽

Faecal Microbiota ◽

Future Directions ◽

Randomized Controlled ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Inflammatory Bowel

Faecal microbiota transplant (FMT) has now been established into clinical guidelines for the treatment of recurrent and refractory Clostridioides difficile infection (CDI). Its therapeutic application in inflammatory bowel disease (IBD) is currently at an early stage. To date, there have been four randomized controlled trials for FMT in IBD and a multitude of observational studies. However, significant gaps in our knowledge regarding optimum methods for FMT preparation, technical aspects and logistics of its administration, as well as mechanistic underpinnings, still remain. In this article, we aim to highlight these gaps by reviewing evidence and making key recommendations on the direction of future studies in this field. In addition, we provide an overview of the current evidence of potential mechanisms of FMT in treating IBD.

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Re-Evaluating the Evidence for Faecal Microbiota Transplantation ‘Super-Donors’ in Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjaa170 ◽

2020 ◽

Cited By ~ 1

Author(s):

Scott W Olesen ◽

Ylaine Gerardin

Keyword(s):

Inflammatory Bowel Disease ◽

Clinical Trials ◽

Bowel Disease ◽

Faecal Microbiota ◽

Faecal Microbiota Transplantation ◽

Recommended Treatment ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Inflammatory Bowel ◽

Rule Out

Abstract Background Faecal microbiota transplantation [FMT] is a recommended treatment for recurrent Clostridioides difficile infection, and there is promise that FMT may be effective for conditions such as inflammatory bowel disease [IBD]. Previous FMT clinical trials have considered the possibility of a ‘donor effect’, that is, that FMT material from different donors has different clinical efficacies. Methods Here we re-evaluate evidence for donor effects in published FMT clinical trials for IBD. Results In ten of 12 published studies, no statistically significant donor effect was detected when rigorously re-evaluating the original analyses. One study showed statistically significant separation of microbiota composition of pools of donor stool when stratified by patient outcome. One study reported a significant effect but did not have underlying data available for re-evaluation. When quantifying the uncertainty on the magnitude of the donor effect, confidence intervals were large, including both zero donor effects and very substantial donor effects. Conclusion Although we found very little evidence for donor effects, the existing data cannot rule out the possibility that donor effects are clinically important. Large clinical trials prospectively designed to detect donor effects are probably needed to determine if donor effects are clinically relevant for IBD.

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P328 Faecal microbiota transplantation as treatment for recurrent Clostridiodes difficile infection in patients with inflammatory bowel disease: Experiences of the Netherlands donor faeces bank

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.457 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S317-S318

Author(s):

E Van Lingen ◽

A E van der Meulen-de Jong ◽

K E W Vendrik ◽

E J Kuijper ◽

E M Terveer ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

The Netherlands ◽

Bowel Disease ◽

Working Group ◽

Indeterminate Colitis ◽

Cure Rate ◽

Faecal Microbiota ◽

Faecal Microbiota Transplantation ◽

Inflammatory Bowel

Abstract Background In recent years Faecal Microbiota Transplantation (FMT) is effectively implemented as an approved treatment approach of refractory Clostridiodes difficile infection (rCDI). In patients with inflammatory bowel disease (IBD) the prevalence of co-infection with CDI is higher than in the general population due to the use of immunosuppressive medication and dysbiosis of the bacteria in the colon. Just a small percentage of IBD patients do have an active CDI infection, not to be confused with carriership. Here we report the treatment course and efficacy of FMT provided by the Netherlands Donor Faeces Bank (NDFB) for IBD patients with rCDI. Methods The NDFB was founded to facilitate FMT by providing ready to use donor faeces suspensions for treatment of patients with rCDI in hospitals throughout The Netherlands. A request for FMT is evaluated by the working group (specialists in the fields of Medical Microbiology, Gastroenterology, and Infectious Diseases) to assess the indication of FMT and to formulate a treatment advice for each individual patient taking the comorbidity into account. Prior to FMT, all patients were pre-treated with vancomycin 250 mg for at least 4 days and bowel lavage. In patients with ulcerative colitis as comorbidity, prednisone was added when there was an IBD flare simultaneous. The results of FMT were monitored by prospective collection of outcome data by the NDFB. Results Since the start of NDFB in March 2016 until August 2019, 186 FMT requests to treat 176 (r)CDI patients were reviewed within the NDFB working group including 26 patients with rCDI and IBD. In total, 129 patients (of which 14 suffered from IBD) were treated with 143 FMTs for CDI with a cure rate of 89.9% after a single FMT (116/129). FMT was deemed not suitable in 12 of 26 patients with IBD because patients had C. Difficile carriership instead of an active CDI infection. Fourteen IBD patients were treated with FMT (9 ulcerative colitis, 2 Crohn’s disease and 2 indeterminate colitis). 3/14 patients suffered from rCDI with an active episode of IBD. Of the 14 IBD patients treated with FMT, only one patient developed a relapse of a CDI infection within 2-months (total cure rate 92%). This cure rate does not differ from CDI patients without IBD. Conclusion In IBD patients with rCDI, FMT is equally effective compared with other patients with rCDI. In case of concurrent activity of IBD, pre-treatment with prednisolone in combination with vancomycin appears to be effective.

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Donor Species Richness Determines Faecal Microbiota Transplantation Success in Inflammatory Bowel Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjv203 ◽

2015 ◽

Vol 10 (4) ◽

pp. 387-394 ◽

Cited By ~ 142

Author(s):

Severine Vermeire ◽

Marie Joossens ◽

Kristin Verbeke ◽

Jun Wang ◽

Kathleen Machiels ◽

...

Keyword(s):

Inflammatory Bowel Disease ◽

Species Richness ◽

Bowel Disease ◽

Faecal Microbiota ◽

Faecal Microbiota Transplantation ◽

Inflammatory Bowel ◽

Donor Species

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Systematic review: faecal microbiota transplantation in the management of inflammatory bowel disease

Alimentary Pharmacology & Therapeutics ◽

10.1111/j.1365-2036.2012.05220.x ◽

2012 ◽

Vol 36 (6) ◽

pp. 503-516 ◽

Cited By ~ 197

Author(s):

J. L. Anderson ◽

R. J. Edney ◽

K. Whelan

Keyword(s):

Systematic Review ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Faecal Microbiota ◽

Faecal Microbiota Transplantation ◽

Inflammatory Bowel

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Healthcare providers’ perception of faecal microbiota transplantation with clostridium difficile infection and inflammatory bowel disease: a quantitative systematic review

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211042679 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110426

Author(s):

Yanghua Liu ◽

Kal Alnababtah ◽

Simon Cook ◽

Ying Yu

Keyword(s):

Systematic Review ◽

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Healthcare Providers ◽

Faecal Microbiota ◽

Cross Sectional ◽

Clostridioides Difficile ◽

Clostridioides Difficile Infection ◽

Inflammatory Bowel ◽

Cross Sectional Studies

Background: Clostridioides difficile infection (CDI) and inflammatory bowel disease (IBD) are global gastroenterological diseases that cause considerable burden on human health, healthcare systems, and society. Faecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridioides Difficile Infection (rCDI) and a promising therapy for IBD. However, indication for FMT in IBD is still unofficial. Consequently, the National Institute for Health and Care Excellence (NICE) is seeking healthcare providers’ advice on whether to update FMT guidelines. Methods: A systematic review methodology was adopted for this study. Five databases (CINAHL, MEDLINE, Cochrane Library, Scopus, Web of Science) and grey literature were systematically searched for English language literature to 14 May 2021. The quality of the included studies was then appraised using the Institute for Public Health Sciences cross-sectional studies tool, after which the findings of the studies were narratively synthesised. Results: Thirteen cross-sectional studies with 4110 validated questionnaire responses were included. Narrative synthesis found that 39.43% of respondents were familiar with FMT (N = 3746, 95%CI = 37.87%–41%), 58.81% of respondents would recommend FMT to their patients (N = 1141, 95%CI = 55.95%–61.67%), 66.67% of respondents considered lack of clinical evidence was the greatest concern regarding FMT (N = 1941, 95%CI = 64.57%–68.77%), and 40.43% respondents would not implement FMT due to concerns about infection transmission (N = 1128, 95%CI = 37.57%–43.29%). Conclusion: Healthcare providers’ knowledge of FMT is relatively low and education is an effective strategy to improve it. As knowledge of FMT increases, willingness to recommend it also increases. Strengthening FMT clinical efficacy and reducing infection can enhance its public acceptance, application and popularity. However, further research is required to explore the donor screening procedure.

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