Kousgaard Sabrina Just, Dall Sebastian Mølvang, Albertsen Mads, Nielsen Hans Linde, Thorlacius-Ussing Ole
Department of Gastrointestinal Surgery, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Gut Microbes. 2025 Dec;17(1):2510464. doi: 10.1080/19490976.2025.2510464. Epub 2025 May 25.
Chronic pouchitis is a common complication after ileal pouch-anal anastomosis (IPAA) with limited treatment options. In this case series, we aimed to investigate clinical and microbiome changes, as well as adverse events, associated with using fecal microbiota transplantation (FMT) from a donor with a normal functioning IPAA to induce remission in patients with chronic pouchitis. Methods The study was a case-series including a 4-week intervention period and 12-month follow-up. Patients with chronic pouchitis who met the inclusion criteria were recruited from the Department of Gastrointestinal Surgery at Aalborg University Hospital, Denmark. Participants received FMT derived from a donor with a normal functioning IPAA. Treatment was administered by enema daily for two weeks, then every other day for two more weeks. Disease severity and quality of life (QoL) were accessed at baseline and 30-day follow-up. Clinical remission was defined as Pouchitis Disease Activity Index (PDAI) <7. Fecal samples from participants, healthy donors, and the IPAA donor were analyzed using shotgun metagenomic sequencing. Results Three patients with chronic pouchitis were included and completed the treatment protocol and follow-up visits. At the 30-day follow-up, all participants achieved clinical remission with reduced endoscopic inflammation. The median total PDAI score decreased from 8 (range 10-8) at baseline to 6 (range 6-5) at 30 days. Two participants reported improved QoL, while one reported no change. Few mild, self-limited adverse events were reported by all participants during treatment, with no serious events. Principal component analysis of fecal samples distinguished two clusters: healthy donors and the IPAA donor, with participant samples forming a separate cluster Conclusion We observed that all participants achieved clinical remission with reduced endoscopic inflammation following a 4-week FMT intervention. Adverse events were mild and self-limited. Metagenomic analysis revealed distinct microbiome clusters between IPAA donor and recipients, both of which differed from those of healthy donors.
慢性袋炎是回肠袋肛管吻合术（IPAA）后常见的并发症，治疗选择有限。在本病例系列中，我们旨在研究将来自IPAA功能正常的供体的粪便微生物群移植（FMT）用于诱导慢性袋炎患者缓解所带来的临床和微生物组变化以及不良事件。方法 本研究为病例系列，包括为期4周的干预期和12个月的随访期。符合纳入标准的慢性袋炎患者从丹麦奥尔堡大学医院胃肠外科招募。参与者接受来自IPAA功能正常的供体的FMT。治疗通过灌肠进行，每天一次，持续两周，然后隔天一次，再持续两周。在基线和30天随访时评估疾病严重程度和生活质量（QoL）。临床缓解定义为袋炎疾病活动指数（PDAI）<7。使用鸟枪法宏基因组测序分析参与者、健康供体和IPAA供体的粪便样本。结果 纳入3例慢性袋炎患者，他们完成了治疗方案和随访。在30天随访时，所有参与者均实现临床缓解，内镜下炎症减轻。PDAI总分中位数从基线时的8（范围10 - 8）降至30天时的6（范围6 - 5）。2名参与者报告QoL改善，1名报告无变化。所有参与者在治疗期间均报告了少数轻度、自限性不良事件，无严重事件。粪便样本的主成分分析区分出两个聚类：健康供体和IPAA供体，参与者样本形成一个单独的聚类。结论 我们观察到，经过4周的FMT干预后，所有参与者均实现临床缓解，内镜下炎症减轻。不良事件轻微且自限性。宏基因组分析显示IPAA供体和接受者之间存在不同的微生物组聚类，两者均与健康供体不同。
