Clinical results and microbiota changes after faecal microbiota transplantation for chronic pouchitis: a pilot study

Abstract

Objectives: Research evidence suggests that chronic pouchitis is associated with intestinal dysbiosis. Faecal microbiota transplantation (FMT) has been proposed as a possible treatment. We performed a 6-month prospective, open-label, single-centre cohort pilot-study (NCT03538366) to investigate if FMT could improve clinical outcome and alter gut microbiota in patients with chronic pouchitis.

Materials and methods: Nine adult patients with chronic pouchitis were included and allocated to 14 days FMT by enemas from five faecal donors, with a 6-month follow-up. Pouchitis severity was assessed using pouchitis disease activity index (PDAI) before and after FMT. Changes in gut microbiota, and engraftment of donor’s microbiota were assessed in faecal samples.

Results: All patients were treated with FMT for 14 continuous days. Overall, four of nine patients receiving FMT were in clinical remission at 30-day follow-up, and three patients remained in remission until 6-month follow-up. Clinical symptoms of pouchitis improved significantly between inclusion and 14-day follow-up (p = .02), but there was no improvement in PDAI between inclusion (mean 8.6) and 30-day follow-up (mean 5.2). Treatment with FMT caused a substantial shift in microbiota and increased microbial diversity in six patients, resembling that of the donors, with a high engraftment of specific donor microbiota.

Conclusions: Symptomatic benefit in FMT treatment was found for four of nine patients with chronic pouchitis with increased microbial diversity and high engraftment of donor’s microbiota. A larger, randomised controlled study is required to fully evaluate the potential role of FMT in treating chronic pouchitis.

Keywords:

• Pouchitis
• IBD
• microbiota
• dysbiosis
• faecal microbiota transplantation
• IPAA

Acknowledgements

The authors thank nurse Ann Hauberg for help with data collection.

Disclosure statement

Mads Albertsen is co-founder and owns part of the DNA analysis company DNASenseApS. Thomas Yssing Michaelsen and Jakob Brandt are part-time employed in DNASenseApS. No competing interests or conflict of interest for the remaining authors have been identified.

Additional information

Funding

Funding has been received from Toyota Foundation, A.P. Møller Foundation, Heinrich Kopp’s research grant and The Crohn and Colitis Foundation to conduct the study. Mads Albertsen was further supported by a research grant (grant number 15510) from VILLUM FONDEN.