Serial Frozen Fecal Microbiota Transplantation in the Treatment of Chronic Intestinal Pseudo-obstruction: A Preliminary Study

Lili Gu, Chao Ding, Hongliang Tian, Bo Yang, Xuelei Zhang, Yue Hua, Yifan Zhu, Jianfeng Gong, Weiming Zhu, Jieshou Li, Ning Li, Lili Gu, Chao Ding, Hongliang Tian, Bo Yang, Xuelei Zhang, Yue Hua, Yifan Zhu, Jianfeng Gong, Weiming Zhu, Jieshou Li, Ning Li

Abstract

Background/aims: Chronic intestinal pseudo-obstruction (CIPO) is a serious, life-threatening motility disorder that is often related to bacterial overgrowth. Fecal microbiota transplantation (FMT) results in restoration of the normal intestinal microbial community structure. We investigated the efficacy of FMT in the treatment of CIPO patients.

Methods: Nine patients (age 18-53 years) with CIPO were enrolled in this prospective, open-label study. Patients received FMT for 6 consecutive days through nasojejunal (NJ) tubes and were followed up for 8 weeks after treatment. We evaluated the rate of clinical improvement and remission, feeding tolerance of enteral nutrition, and CT imaging scores of intestinal obstructions. Lactulose hydrogen breath tests were performed before FMT and 8 weeks after FMT to evaluate for the presence small intestinal bacterial overgrowth (SIBO).

Results: FMT significantly alleviated bloating symptoms, and symptoms of pain were relieved 2 weeks after FMT. Enteral nutrition administered through a NJ tube after FMT was well-tolerated by 66.7% (6/9) of patients. CT scores of intestinal obstructions were significantly reduced after FMT (P = 0.014). SIBO was eliminated in 71.0% (5/7) of patients.

Conclusions: This pilot study demonstrated the safety of using FMT. FMT may relieve symptoms in selected patients with CIPO. FMT may also improve patient tolerance of enteral nutrition delivered via a NJ tube.

Keywords: Fecal microbiota transplantation; Intestinal pseudo-obstruction; Tolerance of enteral nutrition.

Figures

Figure 1
Figure 1
X-ray plain films of Patient 3 at different periods. Abdominal plain radiograph performed in upright position shows multiple distended bowel loops before treatment. No mechanical cause of obstruction is seen. This situation improved significantly after fecal microbiota transplant treatment for 8 weeks. R, right.
Figure 2
Figure 2
CT scan of patient 3 at different periods. Axial CT images obtained at different levels of slice show marked distension and gas-fluid levels. No mechanical cause of obstruction is seen. These symptoms disappeared after serial fecal microbiota transplant (FMT) treatment.

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Source: PubMed

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