Fecal microbiota transplantation for refractory Crohn's disease

Abstract

Approximately one-third of patients with Crohn's disease do not respond to conventional treatments, and some experience significant adverse effects, such as serious infections and lymphoma, and many patients require surgery due to complications. Increasing evidence suggests that specific changes in the composition of gut microbiota, termed as dysbiosis, are a common feature in patients with inflammatory bowel disease (IBD). Dysbiosis can lead to activation of the mucosal immune system, resulting in chronic inflammation and the development of mucosal lesions. Recently, fecal microbiota transplantation, aimed at modifying the composition of gut microbiota to overcome dysbiosis, has become a potential alternative therapeutic option for IBD. Herein, we present a patient with Crohn's colitis in whom biologic therapy failed previously, but clinical remission and endoscopic improvement was achieved after a single fecal microbiota transplantation infusion.

Keywords: Biologic therapy; Crohn disease; Dysbiosis; Fecal microbiota transplantation.

Fig. 1. Initial colonoscopic finding. Colonoscopy at the time of diagnosis reveals deep longitudinal ulcerations in the descending colon.

Fig. 2. Repeat colonoscopic finding. Colonoscopy shows active colitis in the sigmoid colon even after biological therapy was administered.

Fig. 3. Colonoscopic finding after fecal microbiota transplantation (FMT). Follow-up colonoscopy 10 months after FMT shows improvement in mucosal lesions.

Fig. 4. Clinical course of CRP and CDAI during medical therapy.