Exam 3/Lecture 2 Case Study

Question 1

• Fecal microbiota transplantation has been used for how long?
• What is FMT used to treat?
• Limited/heterogeneous results in pts with what?

Answer 1

• FMT has been used >1700 years in traditional Chinese medicine for intestinal diseases
• FMT has been widely and successfully used to treat recurrent Clostridium difficile infections
• Limited/heterogeneous results in pts with IBD even though there is a well- established link between IBD (UC & Crohn’s) with gut biome dysfunction

Question 2

Patient history?

Answer 2

• 2011: 26-yr male presents at ER with perianal fistula:
  – Abnormal communication/tunnel opening between anal epithelium and
  surface skin
• No other GI symptoms, treated with fistulotomy & antibiotics
• April 2012: repeat, not referred to gastroenterology

Question 3

Patient presentation & treatment

• What happened aug 2012
• Lab tests?
• Responds to what?
• Opt for what?
• Undergoes what?
• What does a cecal imaging reveal?

Answer 3

Question 4

What measures IBD activity?

Answer 4

Harvey Bradshaw index measuring IBD activity (bowel movements, abdominal pain)

Question 5

What was the patient outcome?

Answer 5

Question 6

• FMT therapy changed Pt gut biome with disease _
• Unfortunately, Pt discontinued FMT treatments which resulted in _
• Currently maintained on _ (immunosuppressive)
• Incomplete success of FMT for IBD may be related to harsh environment for _ _, host targeted response against new bacteria
• FMT may induce/maintain IBD _ by reversing intestinal dysbiosis

Answer 6

• FMT therapy changed Pt gut biome with disease remission
• Unfortunately, Pt discontinued FMT treatments which resulted in flare up
• Currently maintained on adalimumab (immunosuppressive)
• Incomplete success of FMT for IBD may be related to harsh environment for bacterial colonization, host targeted response against new bacteria
• FMT may induce/maintain IBD remission by reversing intestinal dysbiosis