P335 Patients' perspectives of faecal transplantation for pouchitis

Abstract

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. 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