gut

Antibiotic treatment for inflammatory bowel disease typically does not induce a permanent response. An effective therapy against IBD is not available.

Infusion of fecal material from healthy donor has been reported as an efficient treatment for IBD among children. However, this procedure is limited by the lack of progression assessment among adults. In this study, we compared conventional treatment with gut transplant.

Background:

Inflammatory Bowel Disease is an idiopathic disease caused by deregulation of the immune response to intestinal micro flora. IBD encompasses two forms of intestinal inflammation: Ulcerative colitis and Crohn’s disease.

Crohn’s disease is potentially affects any location of the gastrointestinal tract, but frequently the end of the small bowel. Symptoms include diarrhea, abdominal pain, fever, rectal bleeding, and weight loss also may occur. In counterpart, ulcerative colitis is limited to large bowel only. Approximately, patients with ulcerative colitis have mild symptoms.

The major classes of medication used today to IBD are aminosalicylates, steroids, immune modifiers, and antibiotics (metronidazole, ampicillin, ciprofloxin, others). In one third of patients, medical treatment is not completely successful or complications occur. Under these circumstances, surgery may be considered.

Gut microbiota transplantation has been used to modify normal flora. First reported its use as therapy in1958 for fulminant enterocolitis.

Study intervention and sample preparation:

Healthy donor must be screened for transmissible blood borne diseases. The Donors are not eligible if they have taken antibiotics within last 3 months, because the intestinal micro flora may change. Typically, the donor receives either m...

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The objective was to determine the superiority of gut transplant as compared with conventional therapy. A cure rate of 80% for gut transplantation and 60 % for medical treatment was assumed. 68 patients per group were needed to achieve a power of 80% to detect the difference between the two arms. Progression-free survival analysis was calculated from the day of randomization until the first documented progression or until death from any cause. Kaplan Meier analysis and Cox proportional hazard models used to evaluate for statistical differences. In the event of a dropout, an intention to treat analysis will be performed.

Results:

The inclusion of 68 patients per group was planned. Of 68 patients in infusion group, 78% were cured after the first gut transplantation. Fourteen patients who were cured reported having diarrhea during follow-up