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FMT in IBD

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  1. FMT in IBD Walter Reinisch Department of Medicine McMaster University Hamilton, ON

  2. Grey’s Anatomy, November 2008

  3. Willingness to Undergo FMT in Patients with UC Kahn SA et al. Inflamm Bowel Dis 2013

  4. C. Diff. Infection ≠ IBD C. diff.= Acute Infection IBD = Chronic Inflammation Adapted from Shanahan F et al. Gastroenterology 2014

  5. Dysbiosis in IBD HC = healthy controls, ACD = acute CD, RCD = CD in remission, AUC = acute UC, RUC = UC in remission Wei W et al. JCM 2014

  6. Dysbiosis in IBD: CauseorConsequenceofInflammation

  7. Antibiotics for active UC Nine trials, 622 patients NNT = 7 (95% CI = 4 to 25) Khan KJ et al. AJG 2011

  8. Probiotics for Maintenance of Remission in UC Relapse rate within 1 year Per-Protocol-Analysis (N = 222) 100% 80% Equivalence significant with p = 0,003 60% 36,4% 33,9% 40% 20% 0% E. Coli Nissle MESALAZIN Kruis, W.,etal.Gut2004;

  9. FMT and IBD Management of IBD: 63% disease remission Anderson JL et al. Aliment Pharmacol Ther 2012

  10. 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

  11. Angelberger S et al. AJG 2013

  12. Feces Preparation and Transplantation 250 ml 60 gr 100 ml Angelberger S et al. AJG 2013

  13. Patient Characteristics Angelberger S et al. AJG 2013

  14. FMT design Angelberger S et al. AJG 2013

  15. Safety • no SAE • no „bacterial overgrowth“ (glucose breath test wks 4 and 12) • AEs: Angelberger S et al. AJG 2013

  16. CRP course Angelberger S et al. AJG 2013

  17. Efficacy Angelberger S et al. AJG 2013

  18. Dynamic change in microbiome Angelberger S et al. AJG 2013