FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.
-
Upload
rosamund-conley -
Category
Documents
-
view
223 -
download
0
Transcript of FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.
![Page 1: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/1.jpg)
FMT in IBD
Walter Reinisch
Department of Medicine
McMaster University
Hamilton, ON
![Page 2: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/2.jpg)
Grey’s Anatomy, November 2008
![Page 3: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/3.jpg)
Willingness to Undergo FMT in Patients with UC
Kahn SA et al. Inflamm Bowel Dis 2013
![Page 4: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/4.jpg)
Adapted from Shanahan F et al. Gastroenterology 2014
C. Diff. Infection ≠ IBD
C. diff.=Acute Infection
IBD =Chronic Inflammation
![Page 5: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/5.jpg)
Wei W et al. JCM 2014
Dysbiosis in IBD
HC = healthy controls, ACD = acute CD, RCD = CD in remission, AUC = acute UC, RUC = UC in remission
![Page 6: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/6.jpg)
Dysbiosis in IBD:Cause or Consequence of Inflammation
![Page 7: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/7.jpg)
Antibiotics for active UC
Khan KJ et al. AJG 2011
Nine trials, 622 patients NNT = 7 (95% CI = 4 to 25)
![Page 8: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/8.jpg)
Kruis, W., et al. Gut 2004;
Relapse rate within 1 year
Per-Protocol-Analysis (N = 222)
36,4%
0%
20%
40%
60%
80%
100%
33,9%
Equivalence significant with p = 0,003
E. Coli Nissle MESALAZIN
Probiotics for Maintenance of
Remission in UC
![Page 9: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/9.jpg)
![Page 10: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/10.jpg)
Anderson JL et al. Aliment Pharmacol Ther 2012
FMT and IBD
Management of IBD: 63% disease remission
![Page 11: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/11.jpg)
Heterogeneity among Studies
UC > CD; (some with C.diff infection)
Disease characteristics incomplete (duration, location, disease
activity, endoscopic picture, concomitant treatment)
Patient preparation (lavage, antibiotics, PPI)
Stool preparation (g/mL saline, volume instilled)
Route of administration (naso-gastric, -jejunal, colonoscopy,
enema)
Number of administration (single, multiple)
Donor relationship (relatives, unrelated, one or multiple donors)
Outcomes (subjective, score-based)
Duration of follow-up
![Page 12: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/12.jpg)
Angelberger S et al. AJG 2013
![Page 13: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/13.jpg)
60 gr
250 ml
100 ml
Feces Preparation and Transplantation
Angelberger S et al. AJG 2013
![Page 14: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/14.jpg)
Patient (f/m) 5 (2/3)
Age year, median (range) 27 (22-51)
Age at diagnosis, year, median (range) 26 (18-47)
Extent, n
extensive 4
left-sided 1
Failure to
AZA 4
MTX 2
CsA 3
IFX 4
ADA 2
Median total Mayo Score (range), baseline 11 (8-11)
FMT via enema, gr (range) 20 (6-21.7)
FMT via tube, gr (range) 23.8 (16.7-25)
Antibiotics (Metronidazol), n 5
Probiotics, n 4
Patient Characteristics
Angelberger S et al. AJG 2013
![Page 15: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/15.jpg)
FMT design
Angelberger S et al. AJG 2013
![Page 16: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/16.jpg)
Safety
no SAE
no „bacterial overgrowth“ (glucose breath test wks 4 and 12)
AEs:
FMT, n Follow-up, n
Worsening of diarrhoe 5 Common cold 3
Fever* 5 Itchiness 1
Increase in CRP# 5 Erythema 1
Flatulence 1 Paresthesia (hip) 1
Vomiting 1 Collapse 1
Blister (tongue) 1
Angelberger S et al. AJG 2013
![Page 17: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/17.jpg)
CRP course
Angelberger S et al. AJG 2013
![Page 18: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/18.jpg)
Efficacy
Angelberger S et al. AJG 2013
![Page 19: FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON.](https://reader035.fdocuments.in/reader035/viewer/2022062217/56649d975503460f94a80490/html5/thumbnails/19.jpg)
Dynamic change in microbiome
Angelberger S et al. AJG 2013