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Long-term follow-up of the effects of fecal microbiota transplantation in combination with soluble dietary fiber as a therapeutic regimen in slow transit constipation

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Abstract

As some studies have reported that strategies targeting the gut microbiota such as fecal microbiota transplantation (FMT) with or without other microecological therapy might have efficacy in treating slow transit constipation (STC), we conducted a single-center, open-label trial to study the long-term effect of FMT combined with soluble dietary fiber (pectin) on STC. Thirty-one adult patients with STC were enrolled into the trial. Patients received 6-day FMT procedures repeatedly for the first 3 months and soluble dietary fiber (pectin) daily during the follow-up. The rate of clinical remission and improvement, stool consistency, the Wexner constipation scale, and assessment of constipation-related symptoms were evaluated at week 4 and 1 year later. The clinical remission and improvement rates at week 4 were 69.0% (20/29) and 75.9% (22/29), respectively. At the end of the study, 48.3% (14/29) of patients continued to have at least three complete spontaneous bowel movements per week and 58.6% (17/29) of patients showed clinical improvements. Stool consistency, the Wexner constipation scale, and constipation symptoms improved both at short-term and long-term follow-up. The results indicated that FMT in combination with soluble dietary fiber (pectin) had both short-term and long-term efficacy in treating STC.

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References

  • Agachan, F., Chen, T., Pfeifer, J., Reissman, P., and Wexner, S.D. (1996). A constipation scoring system to simplify evaluation and management of constipated patients. Diseases Colon Rectum 39, 681–685.

    Article  CAS  Google Scholar 

  • Andrews, P., Borody, T.J., Shortis, N.P., and Thompson, S. (1995). Bacteriotherapy for chronic constipation—long term follow-up. Gastroen-terology 108, A563.

    Google Scholar 

  • Aroniadis, O.C., and Brandt, L.J. (2013). Fecal microbiota transplantation. Curr Opin Gastroenterol 29, 79–84.

    Article  PubMed  Google Scholar 

  • Barichella, M., Pacchetti, C., Bolliri, C., Cassani, E., Iorio, L., Pusani, C., Pinelli, G., Privitera, G., Cesari, I., Faierman, S.A., Caccialanza, R., Pezzoli, G., Cereda, E. (2016). Probiotics and prebiotic fiber for constipation associated with Parkinson disease. Neurology 87, 1274–1280.

    Article  PubMed  CAS  Google Scholar 

  • Battaglia, E., Serra, A.M., Buonafede, G., Dughera, L., Chistolini, F., Morelli, A., Emanuelli, G., and Bassotti, G. (2004). Long-term study on the effects of visual biofeedback and muscle training as a therapeutic modality in pelvic floor dyssynergia and slow-transit constipation. Diseases Colon Rectum 47, 90–95.

    Article  Google Scholar 

  • Bharucha, A.E., Pemberton, J.H., and Locke Iii, G.R. (2013). American gastroenterological association technical review on constipation. Gastroenterology 144, 218–238.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bustos Fernández, L.M., Prizont, R., and Soifer, L.O. (2013). A controlled pilot study on the efficacy of a low dose antibiotic for the treatment of chronic constipation in patients receiving a high fiber diet. Acta Gastroenterol Latinoamer 43, 275.

    Google Scholar 

  • Camilleri, M., Kerstens, R., Rykx, A., and Vandeplassche, L. (2008). A placebo-controlled trial of prucalopride for severe chronic constipation. N Engl J Med 358, 2344–2354.

    Article  PubMed  CAS  Google Scholar 

  • Cammarota, G., Ianiro, G., Tilg, H., Rajilić-Stojanović, M., Kump, P., Satokari, R., Sokol, H., Arkkila, P., Pintus, C., Hart, A., Segal, J., Aloi, M., Masucci, L., Molinaro, A., Scaldaferri, F., Gasbarrini, G., Lopez-Sanroman, A., Link, A., de Groot, P., de Vos, W.M., Högenauer, C., Malfertheiner, P., Mattila, E., Milosavljević, T., Nieuwdorp, M., Sanguinetti, M., Simren, M., Gasbarrini, A., Gasbarrini, A. (2017). European consensus conference on faecal microbiota transplantation in clinical practice. Gut 66, 569–580.

    Article  PubMed  PubMed Central  Google Scholar 

  • Celik, A.F., Tomlin, J., and Read, N.W. (1995). The effect of oral vancomycin on chronic idiopathic constipation. Aliment Pharmacol Ther 9, 63.

    Article  PubMed  CAS  Google Scholar 

  • Chassagne, P., Ducrotte, P., Garnier, P., and Mathiex-Fortunet, H. (2017). Tolerance and long-term efficacy of polyethylene glycol 4000 (Forlax ®) compared to lactulose in elderly patients with chronic constipation. J Nutr Health Aging 21, 1–11.

    Article  CAS  Google Scholar 

  • Chaussade, S., Roche, H., Khyari, A., Couturier, D., and Guerre, J. (1986). Measurement of colonic transit time: description and validation of a new method (in French). Gastroenterol Clin Biol 10, 385–389.

    PubMed  CAS  Google Scholar 

  • Chiotakakou-Faliakou, E., Kamm, M.A., Roy, A.J., Storrie, J.B., and Turner, I.C. (1998). Biofeedback provides long term benefit for patients with intractable, slow and normal transit constipation. Gut 42, 517–521.

    Article  PubMed  CAS  Google Scholar 

  • Chumpitazi, B.P., Self, M.M., Czyzewski, D.I., Cejka, S., Swank, P.R., and Shulman, R.J. (2016). Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations. Neurogastroenterol Motil 28, 443–448.

    Article  PubMed  CAS  Google Scholar 

  • Corazziari, E., Badiali, D., Bazzocchi, G., Bassotti, G., Roselli, P., Mastropaolo, G., Lucà, M.G., Galeazzi, R., and Peruzzi, E. (2000). Long term efficacy, safety, and tolerabilitity of low daily doses of isosmotic polyethylene glycol electrolyte balanced solution (PMF-100) in the treatment of functional chronic constipation. Gut 46, 522–526.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Dalziel, J.E., Anderson, R.C., Peters, J.S., Lynch, A.T., Spencer, N.J., Dekker, J., and Roy, N.C. (2017). Promotility action of the probiotic Bifidobacterium lactis HN019 extract compared with prucalopride in isolated rat large intestine. Front Neurosci in press doi: 10.3389/fnins. 2017.00020.

    Google Scholar 

  • de Meij, T.G.J., de Groot, E.F.J., Eck, A., Budding, A.E., Kneepkens, C.M. F., Benninga, M.A., van Bodegraven, A.A., and Savelkoul, P.H.M. (2016). Characterization of microbiota in children with chronic functional constipation. PLoS ONE 11, e0164731.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Dimidi, E., Christodoulides, S., Fragkos, K.C., Scott, S.M., and Whelan, K. (2014). The effect of probiotics on functional constipation in adults: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 100, 1075–1084.

    Article  PubMed  CAS  Google Scholar 

  • Ding, C., Ge, X., Zhang, X., Tian, H., Wang, H., Gu, L., Gong, J., Zhu, W., and Li, N. (2016). Efficacy of synbiotics in patients with slow transit constipation: a prospective randomized trial. Nutrients 8, 605.

    Article  PubMed Central  CAS  Google Scholar 

  • Dipalma, J.A., Cleveland, M.V., McGowan, J., and Herrera, J.L. (2007). A randomized, multicenter, placebo-controlled trial of polyethylene glycol laxative for chronic treatment of chronic constipation. Am J Gastroenterol 102, 1436–1441.

    Article  PubMed  CAS  Google Scholar 

  • Drossman, D.A., Corazziari, E., Delvaux, M., Talley, N.J., Spiller, R., and Thompson, W.G. (2010). Rome III diagnostic criteria for functional gastrointestinal disorders. Revista De Gastroenterol De Mexico 75, 511–516.

    Google Scholar 

  • Drossman, D.A., and Hasler, W.L. (2016). Rome IV—functional GI disorders: disorders of gut-brain interaction. Gastroenterology 150, 1257–1261.

    Article  PubMed  Google Scholar 

  • Fischer, M., Sipe, B., Cheng, Y.W., Phelps, E., Rogers, N., Sagi, S., Bohm, M., Xu, H., and Kassam, Z. (2017). Fecal microbiota transplant in severe and severe-complicated Clostridium difficile: a promising treatment approach. Gut Microbes 8, 289–302.

    Article  PubMed  CAS  Google Scholar 

  • Fischer, M., Sipe, B.W., Rogers, N.A., Cook, G.K., Robb, B.W., Vuppalanchi, R., and Rex, D.K. (2015). Faecal microbiota transplantation plus selected use of vancomycin for severe-complicated Clostridium difficile infection: description of a protocol with high success rate. Aliment Pharmacol Ther 42, 470–476.

    Article  PubMed  CAS  Google Scholar 

  • Ford, A.C., Moayyedi, P., Lacy, B.E., Lembo, A.J., Saito, Y.A., Schiller, L. R., Soffer, E.E., Spiegel, B.M.R., Quigley, E.M.M., Quigley, E.M.M. (2014a). American college of gastroenterology monograph on the management of irritable bowel syndrome and chronic idiopathic constipation. Am J Gastroenterol 109, S2–S26.

    Article  PubMed  Google Scholar 

  • Ford, A.C., Quigley, E.M.M., Lacy, B.E., Lembo, A.J., Saito, Y.A., Schiller, L.R., Soffer, E.E., Spiegel, B.M.R., and Moayyedi, P. (2014b). Efficacy of prebiotics, probiotics, and synbiotics in irritable bowel syndrome and chronic idiopathic constipation: systematic review and meta-analysis. Am J Gastroenterol 109, 1547–1561.

    Article  PubMed  Google Scholar 

  • Ge, X., Ding, C., Gong, J., Tian, H., Wei, Y., Chen, Q., Gu, L., and Li, N. (2016a). Short-term efficacy on fecal microbiota transplantation combined with soluble dietary fiber and probiotics in the treatment of slow transit constipation (in Chinese). Chin J Gastrointest Surgery 19, 1355–1359.

    Google Scholar 

  • Ge, X., Ding, C., Zhao, W., Xu, L., Tian, H., Gong, J., Zhu, M., Li, J., and Li, N. (2017). Antibiotics-induced depletion of mice microbiota induces changes in host serotonin biosynthesis and intestinal motility. J Transl Med 15, 13.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Ge, X., Tian, H., Ding, C., Gu, L., Wei, Y., Gong, J., Zhu, W., Li, N., and Li, J. (2016b). Fecal microbiota transplantation in combination with soluble dietary fiber for treatment of slow transit constipation: a pilot study. Arch Med Res 47, 236–242.

    Article  PubMed  Google Scholar 

  • Graf, D., Cagno, R.D., Fåk, F., Flint, H.J., Nyman, M., Saarela, M., and Watzl, B. (2015). Contribution of diet to the composition of the human gut microbiota. Biochem J 26, 477–480.

    Google Scholar 

  • Ianiro, G., Valerio, L., Masucci, L., Pecere, S., Bibbò, S., Quaranta, G., Posteraro, B., Currò, D., Sanguinetti, M., Gasbarrini, A., Cammarota, G. (2017). Predictors of failure after single faecal microbiota transplantation in patients with recurrent Clostridium difficile infection: results from a 3-year, single-centre cohort study. Clin Microbiol Infect 23, 337.e1–337.e3.

    Article  PubMed  Google Scholar 

  • Iwai, H., Ishihara, Y., Yamanaka, J., and Ito, T. (1973). Effects of bacterial flora on cecal size and transit rate of intestinal contents in mice. Jap J Exp Med 43, 297–305.

    PubMed  CAS  Google Scholar 

  • Kamm, M.A., Dudding, T.C., Melenhorst, J., Jarrett, M., Wang, Z., Buntzen, S., Johansson, C., Laurberg, S., Rosen, H., Vaizey, C.J., Matzel, K., Baeten, C. (2010). Sacral nerve stimulation for intractable constipation. Gut 59, 333–340.

    Article  PubMed  Google Scholar 

  • Khalif, I.L., Quigley, E.M., Konovitch, E.A., and Maximova, I.D. (2005). Alterations in the colonic flora and intestinal permeability and evidence of immune activation in chronic constipation. Dig Liver Dis 37, 838–849.

    Article  PubMed  CAS  Google Scholar 

  • Mearin, F., Lacy, B.E., Chang, L., Chey, W.D., Lembo, A.J., Simren, M., and Spiller, R. (2016). Bowel disorders. Gastroenterology 150, 1393–1407.e5.

    Article  Google Scholar 

  • Lembo, A.J., Kurtz, C.B., Macdougall, J.E., Lavins, B.J., Currie, M.G., Fitch, D.A., Jeglinski, B.I., and Johnston, J.M. (2010). Efficacy of linaclotide for patients with chronic constipation. Gastroenterology 138, 886–895.e1.

    Article  PubMed  CAS  Google Scholar 

  • Li, F., Fu, T., Tong, W.D., Liu, B.H., Li, C.X., Gao, Y., Wu, J.S., Wang, X. F., and Zhang, A.P. (2016). Lubiprostone Is effective in the treatment of chronic idiopathic constipation and irritable bowel syndrome. Mayo Clin Proc 91, 456–468.

    Article  PubMed  CAS  Google Scholar 

  • Li, N., Tian, H., Ma, C., Ding, C., Ge, X., Gu, L., Zhang, X., Yang, B., Hua, Y., Zhu, Y., and Zhou, Y. (2017). Efficacy analysis of fecal microbiota transplantation in the treatment of 406 cases with gastrointestinal disorders (in Chinese). Chin J Gastrointest Surgery 20, 40–46.

    CAS  Google Scholar 

  • Liu, Z., Yan, S., Wu, J., He, L., Li, N., Dong, G., Fang, J., Fu, W., Fu, L., and Sun, J. (2016). Acupuncture for chronic severe functional constipation: a randomized trial. Ann Intern Med 165, 761.

    PubMed  Google Scholar 

  • Metcalf, A.M., Phillips, S.F., Zinsmeister, A.R., MacCarty, R.L., Beart, R. W., and Wolff, B.G. (1987). Simplified assessment of segmental colonic transit. Gastroenterology 92, 40–47.

    Article  PubMed  CAS  Google Scholar 

  • Michael, C., Hubert, P., Yan, Y., Jan, T., René, K., Quigley, E.M.M., Ke, M. Y., Da, S.S., and Amy, L. (2016). Efficacy and safety of prucalopride in chronic constipation: an integrated analysis of six randomized, controlled clinical trials. Dig Dis Sci 148, 2357–2372.

    Google Scholar 

  • Moayyedi, P., Surette, M.G., Kim, P.T., Libertucci, J., Wolfe, M., Onischi, C., Armstrong, D., Marshall, J.K., Kassam, Z., Reinisch, W., Lee, C.H. (2015). Fecal microbiota transplantation induces remission in patients with active ulcerative colitis in a randomized controlled trial. Gastroenterology 149, 102–109.e6.

    Article  PubMed  Google Scholar 

  • Ojetti, V., Ianiro, G., Tortora, A., D’Angelo, G., Di, R.T., Bibbò, S., Migneco, A., and Gasbarrini, A. (2014). The effect of Lactobacillus reuteri supplementation in adults with chronic functional constipation: a randomized, double-blind, placebo-controlled trial. J Gastrointest Liver Dis 23, 387–391.

    Google Scholar 

  • Paramsothy, S., Kamm, M.A., Kaakoush, N.O., Walsh, A.J., van den Bogaerde, J., Samuel, D., Leong, R.W.L., Connor, S., Ng, W., Paramsothy, R., Xuan, W., Lin, E., Mitchell, H.M., Borody, T.J. (2017). Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet 389, 1218–1228.

    Article  PubMed  Google Scholar 

  • Parthasarathy, G., Chen, J., Chen, X., Chia, N., O’Connor, H.M., Wolf, P. G., Gaskins, H.R., and Bharucha, A.E. (2016). Relationship between microbiota of the colonic mucosa vs feces and symptoms, colonic transit, and methane production in female patients with chronic constipation. Gastroenterology 150, 367–379.e1.

    Article  PubMed  Google Scholar 

  • Patton, V., Stewart, P., Lubowski, D.Z., Cook, I.J., and Dinning, P.G. (2016). Sacral nerve stimulation fails to offer long-term benefit in patients with slow-transit constipation. Dis Colon Rectum 59, 878.

    Article  PubMed  Google Scholar 

  • Pikarsky, A.J., Singh, J.J., Weiss, E.G., Nogueras, J.J., and Wexner, S.D. (2001). Long-term follow-up of patients undergoing colectomy for colonic inertia. Diseases Colon Rectum 44, 179–183.

    Article  CAS  Google Scholar 

  • Rao, S.S., Rattanakovit, K., and Patcharatrakul, T. (2016). Diagnosis and management of chronic constipation in adults. Nat Rev Gastroenterol Hepatol 13, 295–305.

    Article  PubMed  CAS  Google Scholar 

  • Stern, T., and Davis, A.M. (2016). Evaluation and treatment of patients with constipation. JAMA 315, 192–193.

    Article  PubMed  CAS  Google Scholar 

  • Suares, N.C., and Ford, A.C. (2011). Prevalence of, and risk factors for, chronic idiopathic constipation in the community: systematic review and meta-analysis. Am J Gastroenterol 106, 1582–1591.

    Article  PubMed  Google Scholar 

  • Tack, J., van Outryve, M., Beyens, G., Kerstens, R., and Vandeplassche, L. (2009). Prucalopride (Resolor) in the treatment of severe chronic constipation in patients dissatisfied with laxatives. Gut 58, 357–365.

    Article  PubMed  CAS  Google Scholar 

  • Tian, H., Ding, C., Gong, J., Ge, X., McFarland, L.V., Gu, L., Wei, Y., Chen, Q., Zhu, W., Li, J., Li, N. (2016). Treatment of slow transit constipation with fecal microbiota transplantation. J Clin Gastroenterol 50, 865–870.

    Article  PubMed  Google Scholar 

  • Tian, H., Ge, X., Nie, Y., Yang, L., Ding, C., McFarland, L.V., Zhang, X., Chen, Q., Gong, J., Li, N. (2017). Fecal microbiota transplantation in patients with slow-transit constipation: a randomized, clinical trial. PLoS ONE 12, e0171308.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Webster, C., and Dayton, M. (2001). Results after colectomy for colonic inertia: a sixteen-year experience. Am J Surgery 182, 639–644.

    Article  CAS  Google Scholar 

  • Wei, Y., Gong, J., Zhu, W., Tian, H., Ding, C., Gu, L., Li, N., and Li, J. (2016). Pectin enhances the effect of fecal microbiota transplantation in ulcerative colitis by delaying the loss of diversity of gut flora. BMC Microbiol 16, 255.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Woodward, S., Norton, C., and Chiarelli, P. (2014). Biofeedback for treatment of chronic idiopathic constipation in adults. Cochrane Database Syst Rev 89, CD008486.

    Google Scholar 

  • Yiannakou, Y., Piessevaux, H., Bouchoucha, M., Schiefke, I., Filip, R., Gabalec, L., Dina, I., Stephenson, D., Kerstens, R., Etherson, K., Levine, A. (2015). A randomized, double-blind, placebo-controlled, phase 3 trial to evaluate the efficacy, safety and tolerability of prucalopride in men with chronic constipation. Am J Gastroenterol 110, 741–748.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Zoppi, G., Cinquetti, M., Luciano, A., Benini, A., Muner, A., and Minelli, E.B. (1998). The intestinal ecosystem in chronic functional constipation. Acta Paediatr 87, 836–841.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

We would like to thank Yue Hua, Yifan Zhu, Xuelei Zhang, Zhengjin Xie, Yan Zhou, Chunlian Ma and Lingling Huang from Jinling Hospital for their work in the collection of patients’ information. This work was supported by the National Natural Science Foundation of China (81670493) (http://www.nsfc.gov.cn/publish/portal1/) and by the National Gastroenterology Research Project (2015BAI13B07). We thank Kate Fox, DPhil, from Liwen Bianji, Edanz Group China (www.liwenbianji.cn/ac), for editing the English text of a draft of this manuscript. The funders had no role in study design, data collection and analysis, the decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210093, China

    Xueying Zhang, Lili Gu, Chao Ding, Xiaolong Ge, Jianfeng Gong & Ning Li

  2. Shanghai Tenth People’s Hospital, Tenth People’s Hospital of Tongji University, Shanghai, 200072, China

    Hongliang Tian, Bo Yang & Ning Li

  3. Institute of Digestive Diseases, Xi Jing Hospital, Fourth Military Medical University, Xi’an, 710032, China

    Yongzhan Nie

  4. Department of General Surgery, Drum Tower Hospital, Medical School of Nanjing University, Nanjing, 210008, China

    Chao Ding

  5. Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China

    Xiaolong Ge

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Zhang, X., Tian, H., Gu, L. et al. Long-term follow-up of the effects of fecal microbiota transplantation in combination with soluble dietary fiber as a therapeutic regimen in slow transit constipation. Sci. China Life Sci. 61, 779–786 (2018). https://doi.org/10.1007/s11427-017-9229-1

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