Anas Almoghrabi, MD1, Chimezie Mbachi, MD2, Estefania Flores, MD2, Melchor V. Demetria, MD1, Bashar M. Attar, MD, PhD1
1Cook County Health and Hospital Systems, Chicago, IL; 2John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
Introduction: Fecal microbiota transplantation for treatment of IBD is an off-label use since it has not been approved for the FDA. But its use has been approved as one of the treatment options in recurrent C. difficile infection. The efficacy of self-administered home fecal transplant has not been studied in patients with Crohn's disease.
Case Description/Methods: A 46 years old woman with history of Crohn’s pancolitis with perianal fistulae diagnosed when she presented with chronic bloody diarrhea, her colonoscopy showed severe colitis characterized by deep ulcers throughout the colon (Figure a-b). Biopsies showed cryptitis and crypt abscesses. She was started on prednisone and azathioprine. She refused biologic treatments because of concerns about side effects. During this time, she developed frequent upper respiratory infections so she self-stopped azathioprine. She initiated a series of self-administered home fecal transplants and continued to do them when she began to feel symptomatic again. She presented to our GI clinic four years later. She denied any abdominal pain, diarrhea, melena, hematochezia, or weight loss. On physical examination her vitals were within normal limits, her abdomen was soft and non-tender. On anal exam, few skin tags were observed, no fistulae. Laboratories were within normal limits, including C-reactive protein. Repeat colonoscopy showed normal terminal ileum, multiple pseudopolyps throughout the colon (Figure 1,2,3,4). Random colon biopsies showed quiescent disease.
Discussion: There is some evidence that suggests changes in the gut microbiota in patients with IBD. These changes over-activate the mucosa immune system leading to chronic inflammation and mucosal lesions. A substantial proportion of patients do not respond to the currently available drugs, most of them immunosuppressive therapy with potential long-term consequences. Consequently, alternative safer therapies are being studied, such as fecal microbiota transplantation. Despite all the studies and investigation in this regard, the FDA only allows the use of FMT for recurrent C. difficile but has tighter restrictions for IBD. In this scenery, those patients can only get a fecal transplant in a medical setting if they are participating in a clinical trial. A handful of case reports have shown the effectiveness of self-administered home fecal transplant in recurrent C. difficile, and the efficacy of FMT, under monitored environment, in refractory CD unresponsive to current conventional therapy.
Citation: Anas Almoghrabi, MD; Chimezie Mbachi, MD; Estefania Flores, MD; Melchor V. Demetria, MD; Bashar M. Attar, MD, PhD. P1441 - THE EFFICACY OF SELF-ADMINISTERED HOME FECAL TRANSPLANT IN INDUCING AND MAINTAINING REMISSION IN CROHN'S PAN-COLITIS WITH PERIANAL FISTULAE. Program No. P1441. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.