Fecal Microbiota Transplantation for Treatment of Recurrent Clostridiodes difficile Effective in UC

Clostridioides difficile bacteria
Illustration of the bacteria Clostridioides difficile. These rod shaped bacteria have flagella, which are used for motility. Clostridioides difficile (formerly known as Clostridium difficile) are anaerobic bacteria prevalent in soil. In humans, the bacteria can become established in the colon and disrupt the normal gut microbiota, particularly in people taking antibiotics. Toxins released by Clostridioides difficile can produce diarrhoea and inflammation.
Researchers assessed the microbial profiles of patients with IBD with recurrent C. difficile infection.

The following article is part of coverage from Digestive Disease Week (DDW 2020). Due to the global COVID-19 pandemic, the American Gastroenterology Association made the necessary decision to cancel the meeting originally scheduled for May 2–May 5, 2020, in Chicago. While live events will not proceed as planned, readers can click here catch up on the latest research intended to be presented at the meeting.

Following fecal microbiota transplantation (FMT), patients with ulcerative colitis (UC) showed greater efficiency of engraftment than patients with Crohn disease (CD), according to results of an open label, prospective, single-arm, multicenter cohort study intended to be presented at Digestive Disease Week 2020.

Recurrent Clostridiodes difficile infection (CDI) poses a major challenge to treating patients with inflammatory bowel disease (IBD). Although data on patients with IBD and CDI are limited, FMT appears to be a promising therapy.

Researchers gathered data from patients at 4 tertiary care centers in the United States. Single colonoscopic FMTs from a universal stool bank were administered to patients with IBD who experienced 2 or more episodes of CDI. FMT failure up to week 8 — defined as diarrhea and enzyme immunoassay and toxin for C difficile — was the primary outcome. New IBD flares, worsened IBD condition, and IBD improvement based on HBI or Mayo scores were listed as secondary outcomes. Testing for CDI occurred prior to FMT, and at weeks 1, 8, and 12 after FMT. The researchers determined stool microbial profiles using 16S rRNA sequencing.

Of the 50 participants, 14 had CD (mean HBI score, 6.4) and 36 had UC (mean partial Mayo score, 4.5). The mean age of participants was 43.3 years, and 56% of them were female (n=28). In total, 6 participants received FMT twice and 4 experienced FMT failure upon initial procedure. In the UC group, 57% of patients showed improvement in IBD, and 4% had new flares. In the CD group, 64% of patients showed improvement in IBD. Within the first week of FMT, gut microbial diversity increased significantly. Compared with patients with UC, those with CD showed microbial compositions similar to donors (P =.03). There was a weak correlation between improvement in UC condition and Proteobacteria decolonization. There was no noted association between increases in microbial diversity or similarity to donor microbiome and IBD improvement.

The researchers note that further trials are needed to assess the microbial effect of FMT on patients with IBD and CDI. However, this study showed that more efficient engrafting occurred in patients with UC rather than CD following FMT.

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Allegretti JR, Hurtado J, Carrellas M, et al. Ulcerative colitis patients achieve more robust engraftment compared to patients with Crohn’s Disease after fecal microbiota transplantation for the treatment of recurrent C. Difficle infection. Abstract intended to be presented at Digestive Disease Week 2020; May 2020 (canceled). Chicago, Illinois, United States of America.