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Colonic distribution of FMT by different enema procedures compared to colonoscopy – proof of concept study using contrast fluid

Abstract

Background Fecal microbiota transplantation (FMT) has become an important treatment method in recurrent Clostridioides difficile infections and is under investigation as a treatment for several other diseases. FMT’s mechanism of action is assumed to be through alterations of the colon microbiota. FMT can be delivered by several methods, but few studies have directly compared how FMT is distributed in the colon by different methods. Specifically, the proximal distribution of FMT delivered by enema is unknown.

Methods In eight participants, we administered contrast fluid (CF) with viscosity similar to an FMT in a crossover study design. First, CF was administered by colonoscopy, followed by an abdominal X-ray to visualize the CF distribution. Next, after four to eight weeks, participants were given CF, but as an enema, followed by a positioning procedure. X-rays were obtained before (enema ÷) and after (enema +) the positioning procedure.

Conclusion Proportion of participants with CF in cecum were 100% after colonoscopy, 50% after enema+and 38% after enema ÷. In the transverse colon, proportions were 100% (colonoscopy), 88% (enema +) and 63% (enema ÷). There were no adverse events.

Interpretation This study shows proof of concept for the distribution of FMT to proximal colon when delivered by enema. A positioning procedure after the enema slightly improves the proximal distribution. However, colonoscopy is the only method that ensures delivery to the cecum. Studies are needed to see if FMT colon distribution correlates with treatment effectiveness.

Trial registration The study was retrospectively registered at ClinicalTrials.gov (NCT05121285) (16/11/2021).

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Category

Academic article

Language

English

Author(s)

  • Linn Skjevling
  • Hege Marie Hanssen
  • Per Christian Valle
  • Rasmus Goll
  • Frederik Emil Juul
  • Øystein Arlov
  • Peter Holger Johnsen

Affiliation

  • SINTEF Industry / Biotechnology and Nanomedicine
  • UiT The Arctic University of Norway
  • University Hospital of North Norway
  • Oslo University Hospital

Year

2023

Published in

BMC Gastroenterology

Volume

23

View this publication at Norwegian Research Information Repository