Fecal Microbial Transplantation for the Treatment of Fecal Incontinence in Women (FMT for FI)

Fecal Microbial Transplantation (FMT) For the Treatment of Fecal Incontinence in Women

Open label pilot study assessing FMT to treat fecal incontinence in women 50 years of age and older.

Study Overview

• Status: Terminated
• Conditions: Fecal Incontinence
• Intervention / Treatment: Biological: fecal microbial transplantation (FMT)

Detailed Description

Fecal incontinence, also known as accidental bowel leakage, is a common condition that is an immense burden to older women, caregivers, and the health care system. The overall goal of this study is to gather pilot data in order to conduct a future randomized controlled trial (RCT) for a novel treatment for fecal incontinence in older women utilizing fecal microbial transplantation (FMT). The investigator's hypothesis is that infusion of intestinal microbiota from healthy donors to older women with fecal incontinence will increase microbial diversity, reduce symptom severity, and improve quality of life. This study is a single arm, open-label clinical trial of FMT for the treatment of fecal incontinence refractory to conservative management. The investigators will measure the impact of FMT on change in symptom severity and quality of life and stool microbial diversity at 4 and 12 weeks after FMT.

• Study Type: Interventional
• Enrollment (Actual): 10
• Phase: Phase 2; Phase 1

Contacts and Locations

• Study Contact: Name: Uduak U Andy, MD; Phone Number: 215-662-7366; Email: uduakumoh.andy@pennmedicine.upenn.edu

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Hospital of the University of Pennsylvania

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 50 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Women 50 years of age and older with self-reported fecal incontinence defined as:
• Uncontrolled bothersome loss of liquid or solid fecal material that occurs at least weekly over the last 3 months and
• Failure of response to conservative management using fiber, diet modification, supervised pelvic floor exercises
• Baseline St. Mark's score of greater than or equal to 12
• Intolerance, unwillingness or inadequate response to constipating medications
• Self-reported current negative colon cancer screening based on the 2016 US preventive Services Task Force recommendation (applies to participants age 50-75). N/A if participant is over 75
• Able and willing to sign the informed consent form and agree with study procedures

Exclusion Criteria:

• Known food allergy that could lead to anaphylaxis
• Contraindications to naso-gastric tube placement including:
• Recent mid-face trauma
• History basilar skull fracture
• Recent ENT surgery
• Known coagulation abnormalities
• Esophageal varices and/or esophageal strictures
• Untreated prolapse beyond the hymen
• History of Inflammatory Bowel Disease (does not include IBS)
• Unrepaired rectovaginal fistula/chronic 4th degree laceration
• Full thickness rectal prolapse
• History of congenital anorectal malformation
• History of bowel resection surgery for any indication
• Minor anal procedures within 6 months for treatment of accidental bowel leakage (ABL) (injection of bulking agent or radiofrequency energy) or ligation of hemorrhoids
• Prior pelvic or abdominal radiation
• Diagnosis of cancer of the descending colon or anus

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: FMT Administration; This is a single arm study in which all eligible participants will receive FMT.	Biological: fecal microbial transplantation (FMT); Fecal microbial transplantation (FMT) is the infusion of intestinal microbiota from healthy donors.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine if fecal microbial transplantation leads to clinical improvement in refractory fecal incontinence in older women.	Number of subjects that shows significant improvement at 4 weeks after FMT, and will be maintained at 12 weeks, relative to baseline using the St. Mark's Vaizey score, a measure of fecal incontinence severity.	84 days
Determine the safety of FMT administration via naso-gastric tube in older women with FI.	Frequency of adverse events, serious adverse events, and adverse events of special interest (including allergic reaction and gastrointestinal symptoms).	6 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine if FMT leads to improved quality of life for subjects.	Number of subjects that have an improved quality of life at 4 and 12 weeks, measured by the FIQL scale.	84 days
Determine if the effectiveness of microbial engraftment following fecal microbial transplantation is associated with the degree of clinical improvement.	Concentration of Microbiota present at baseline vs at week 4 in subjects that demonstrate a significant improvement at 4 weeks after FMT, relative to baseline using the St. Mark's Vaizey score.	28 days

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Determine whether the baseline microbiota of the subject affects engraftment in fecal microbial transplantation for fecal incontinence.	Concentration of microbiota at baseline vs concentration of microbiota at 4 weeks.	28 days

Collaborators and Investigators

• Sponsor: University of Pennsylvania
• Investigators: Principal Investigator: Uduak U Andy, MD, University of Pennsylvania

Study record dates

Study Major Dates

• Study Start (Actual): January 14, 2021
• Primary Completion (Actual): January 18, 2023
• Study Completion (Actual): January 18, 2023

Study Registration Dates

• First Submitted: December 13, 2019
• First Submitted That Met QC Criteria: December 13, 2019
• First Posted (Actual): December 17, 2019

Study Record Updates

• Last Update Posted (Estimated): December 5, 2023
• Last Update Submitted That Met QC Criteria: December 4, 2023
• Last Verified: December 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Digestive System Diseases; Gastrointestinal Diseases; Intestinal Diseases; Rectal Diseases; Fecal Incontinence
• Other Study ID Numbers: IRB# 834196

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No