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P335 Patients' perspectives of faecal transplantation for pouchitis
Clinical: Therapy and observation
S143 Conclusions: Patients with chronic pouchitis would not be averse to faecal transplantation therapy for their disease. It is not, however a treatment of first preference for the group of patients surveyed. Patients were more averse to nasogastric tube insertion than faecal transplantation itself and lower gastrointestinal administration would be preferred by this patient group. Further studies of other patient groups with gastrointestinal diseases who might benefit from faecal transplantation therapy should be undertaken to assess the acceptibility of this treatment to patients. P336 The effect of granulocyte and monocyte adsorption for Crohn’s disease patients with loss of response or adverse events for anti-TNF-a therapy K. Koji1 *, F. Ken1 , M. Takayuki1 . 1 Division of Lower Gastoenterology, Department of Internal Medicine, Nishinomiya, Japan
Relationship between C-reactive protein concentrations and infliximab trough concentration. Observed data are represented by open circles and model-predicted data are represented by the curve. Conclusions: Our study quantifies the concentration effect relationhip of IFX in Crohn’s disease and suggests an optimal trough concentration of around 5 mg/L. P335 Patients’ perspectives of faecal transplantation for pouchitis J. Landy1 *, Z.L. Perry-woodford1 , S.K. Clark2 , A. Hart3 . St Mark’s Hospital, London, United Kingdom, 2 St Mark’s Hospital, Colorectal Surgery, London, United Kingdom, 3 St Mark’s Hospital, Gastroenterology, London, United Kingdom 1
Background: Faecal transplantation has been reported as therapy for Clostridium difficile, constipation, irritable bowel syndrome and inflammatory bowel diseases. In recent years there has been a resurgence of interest in this procedure and its therapeutic potential by modifying the gut microbiota in chronic gastrointestinal disorders. However, patient aversion could be a significant obstacle to the use of faecal transplantation therapy. To our knowledge there are no previous reports of patients’ attitudes to this potential therapy. Methods: Consecutive patients with pouchitis seen in the outpatient clinic over a 10 week period were informed regarding faecal transplantation therapy using written information sheets explaining the procedure. They subsequently completed a 15 point questionnaire. Results: 19 patients completed the survey. 17 patients had a clinical, endoscopic and histological diagnosis of chronic pouchitis and 2 recurrent pouchitis less than 3 times per year. The mean age was 50 years (range 24 61 years). The mean time since restorative proctocolectomy was 13.3 years (range 2 30 years). Mean pouch frequency was 10x/24 h and 2x/night. 19/19 patients responded that they would consider faecal transplantation therapy for their pouchitis. The majority (10/19) of patients responded that a nasogastric tube insertion would be the greatest aversion to undertaking this therapy. The most preferred administration method was via endoscopy or enema into the lower gastrointestinal tract (14/19). 12/19 patients would consider self administration of faecal enemas at home. Faecal transplantation was preferred as a potential treatment option to longterm immunsuppression, enema therapies, steroids and permanent ileostomy. Longterm antibiotic therapy was a preferred treatment option to faecal transplantation.
Background: Dysregulated peripheral immune profile is known to have an important role in the initiation and perpetuation of Crohn’s disease (CD) and recently, anti-cytokine therapy with biologics has been recognized as a major therapeutic option for CD, which is refractory to conventional medications. In Japan, infliximab (IFX) and adalimumab (ADA) have recently become available for clinical application. These biologics have been associated with a significant improvement of patients’ quality of life. However, it has been recognized that many patients who initially respond well to IFX or ADA subsequently become refractory or intolerant to these biologics. In such cases, we have been administering corticosteroid or immunosuppressant. Methods: We hypothesized that therapeutic granulocyte and monocyte adsorption (GMA) as an extracorporeal haemoadsorption, which can eliminate elevated and activated leucocytes of the myeloid linage might be effective in CD patient refractory to anti-TNF-a therapy. Subjects were 25 CD patients with an average CD activity index (CDAI) of 242.71 and CD duration of 8.5 years. And the average of simple endoscopic score for Crohn’s disease (SES-CD) was 15.07. The 11 patients had lost response to anti-TNF-a therapy, and 4 patients had developed severe adverse reactions to anti-TNF-a therapy. We applied 5 10, once a week GMA sessions instead of IFX for remission induction. Three patients who had achieved remission with ADA received one GMA session every two weeks as maintenance therapy. Similarly, 4 patients who were receiving scheduled maintenance IFX at 8 weeks intervals received 3 4 weekly GMA sessions due to a rise in their CDAI scores while under maintenance IFX therapy. Results: Nineteen of 25 patients who had lost response to IFX or ADA responded well to GMA with a significant fall in CDAI scores and SES-CD scores (P < 0.05). Four patients could discontinue prednisone and IFX. Further, IFX and GMA combination therapy has associated with a sustained clinical remission without experiencing side effects or the need to shorten the interval or increase the dose of IFX. Patients who received GMA in combination with IFX developed no adverse side effect. Conclusions: Anti-TNF-a therapy appears to induce and maintain remission of CD, but following repeated administration, many patients lose response or develop severe side effects. GMA is safe and by selectively depleting elevated/activated leucocytes could be an effective adjunct therapy to enhance the clinical benefit of IFX.
S143 Conclusions: Patients with chronic pouchitis would not be averse to faecal transplantation therapy for their disease. It is not, however a treatment of first preference for the group of patients surveyed. Patients were more averse to nasogastric tube insertion than faecal transplantation itself and lower gastrointestinal administration would be preferred by this patient group. Further studies of other patient groups with gastrointestinal diseases who might benefit from faecal transplantation therapy should be undertaken to assess the acceptibility of this treatment to patients. P336 The effect of granulocyte and monocyte adsorption for Crohn’s disease patients with loss of response or adverse events for anti-TNF-a therapy K. Koji1 *, F. Ken1 , M. Takayuki1 . 1 Division of Lower Gastoenterology, Department of Internal Medicine, Nishinomiya, Japan
Relationship between C-reactive protein concentrations and infliximab trough concentration. Observed data are represented by open circles and model-predicted data are represented by the curve. Conclusions: Our study quantifies the concentration effect relationhip of IFX in Crohn’s disease and suggests an optimal trough concentration of around 5 mg/L. P335 Patients’ perspectives of faecal transplantation for pouchitis J. Landy1 *, Z.L. Perry-woodford1 , S.K. Clark2 , A. Hart3 . St Mark’s Hospital, London, United Kingdom, 2 St Mark’s Hospital, Colorectal Surgery, London, United Kingdom, 3 St Mark’s Hospital, Gastroenterology, London, United Kingdom 1
Background: Faecal transplantation has been reported as therapy for Clostridium difficile, constipation, irritable bowel syndrome and inflammatory bowel diseases. In recent years there has been a resurgence of interest in this procedure and its therapeutic potential by modifying the gut microbiota in chronic gastrointestinal disorders. However, patient aversion could be a significant obstacle to the use of faecal transplantation therapy. To our knowledge there are no previous reports of patients’ attitudes to this potential therapy. Methods: Consecutive patients with pouchitis seen in the outpatient clinic over a 10 week period were informed regarding faecal transplantation therapy using written information sheets explaining the procedure. They subsequently completed a 15 point questionnaire. Results: 19 patients completed the survey. 17 patients had a clinical, endoscopic and histological diagnosis of chronic pouchitis and 2 recurrent pouchitis less than 3 times per year. The mean age was 50 years (range 24 61 years). The mean time since restorative proctocolectomy was 13.3 years (range 2 30 years). Mean pouch frequency was 10x/24 h and 2x/night. 19/19 patients responded that they would consider faecal transplantation therapy for their pouchitis. The majority (10/19) of patients responded that a nasogastric tube insertion would be the greatest aversion to undertaking this therapy. The most preferred administration method was via endoscopy or enema into the lower gastrointestinal tract (14/19). 12/19 patients would consider self administration of faecal enemas at home. Faecal transplantation was preferred as a potential treatment option to longterm immunsuppression, enema therapies, steroids and permanent ileostomy. Longterm antibiotic therapy was a preferred treatment option to faecal transplantation.
Background: Dysregulated peripheral immune profile is known to have an important role in the initiation and perpetuation of Crohn’s disease (CD) and recently, anti-cytokine therapy with biologics has been recognized as a major therapeutic option for CD, which is refractory to conventional medications. In Japan, infliximab (IFX) and adalimumab (ADA) have recently become available for clinical application. These biologics have been associated with a significant improvement of patients’ quality of life. However, it has been recognized that many patients who initially respond well to IFX or ADA subsequently become refractory or intolerant to these biologics. In such cases, we have been administering corticosteroid or immunosuppressant. Methods: We hypothesized that therapeutic granulocyte and monocyte adsorption (GMA) as an extracorporeal haemoadsorption, which can eliminate elevated and activated leucocytes of the myeloid linage might be effective in CD patient refractory to anti-TNF-a therapy. Subjects were 25 CD patients with an average CD activity index (CDAI) of 242.71 and CD duration of 8.5 years. And the average of simple endoscopic score for Crohn’s disease (SES-CD) was 15.07. The 11 patients had lost response to anti-TNF-a therapy, and 4 patients had developed severe adverse reactions to anti-TNF-a therapy. We applied 5 10, once a week GMA sessions instead of IFX for remission induction. Three patients who had achieved remission with ADA received one GMA session every two weeks as maintenance therapy. Similarly, 4 patients who were receiving scheduled maintenance IFX at 8 weeks intervals received 3 4 weekly GMA sessions due to a rise in their CDAI scores while under maintenance IFX therapy. Results: Nineteen of 25 patients who had lost response to IFX or ADA responded well to GMA with a significant fall in CDAI scores and SES-CD scores (P < 0.05). Four patients could discontinue prednisone and IFX. Further, IFX and GMA combination therapy has associated with a sustained clinical remission without experiencing side effects or the need to shorten the interval or increase the dose of IFX. Patients who received GMA in combination with IFX developed no adverse side effect. Conclusions: Anti-TNF-a therapy appears to induce and maintain remission of CD, but following repeated administration, many patients lose response or develop severe side effects. GMA is safe and by selectively depleting elevated/activated leucocytes could be an effective adjunct therapy to enhance the clinical benefit of IFX.