What is Crohn’s Disease (CD)?
CD is a chronic, recurrent inflammatory disease of the intestinal tract. The two primary sites for Crohn’s disease are the ileum, which is the last portion of the small bowel (ileitis, regional enteritis), and the colon (Crohn’s colitis). The condition begins as small, microscopic nests of inflammation which persist and enlarge. The lining of the bowel can then become ulcerated and the bowel wall thickened. Eventually, the bowel may become narrowed or obstructed and surgery may be needed.
How is a diagnosis made?
The patient’s medical history and physical exam are always helpful. Certain blood and stool tests are performed to arrive at a diagnosis. X-rays of the small intestine and colon (obtained through an upper GI series and barium enema) are usually required. In addition, a visual examination (sigmoidoscopy) of the lining of the rectum and lower bowel is usually necessary. A more thorough exam of the entire colon (colonoscopy) is often the best way of diagnosing the problem when the disease is in the colon.
Why consider Human Microbiota Transplant (HMT) for symptoms related to Crohn’s Disease?
There are consistent changes to the gut microbiota in IBD patients. At a high-level, these changes may be characterized as a decrease in the diversity of the gut microbiome, shifting into a state of imbalance (known as dysbiosis). The goal of HMT is to restore the balance in the gut microbiome. For this reason, HMT has been studied as a procedure for the management of the symptoms of Crohn’s Disease. In a recent meta-analysis, 42 out of 82 (50.5%) CD patients achieved clinical remission after a course of fecal microbiota transplant treatment with no major side effects observed.
What does the Hong Kong HMT programme involved?
Our centre works closely with renowned gastroenterologists in the region. Our HMT treatment programme is based on protocols from our GI specialist advisors, while taking into account the specific needs of the individual. Our programme is designed to help you get relief and long-term benefit from the symptoms of your condition by restoring the balance of microbiota in your gut.
- Patients will undergo HMT implants on five consecutive days, or on two sets of five consecutive days (10 days total) over a period of 2-3 weeks.
- HMT implants may be delivered via enema, capsules oral formulation, or colonoscopy (additional fees required)
- Prior to undergoing HMT therapy, individuals will undergo a bowel preparation consisting of either standard bowel prep or colonic water lavage.
The goal of Human Microbiota Transplant (HMT) is to help rebalance the gut microbiota, which may alleviate some of the symptoms of a GI-related condition. Crohn’s Disease is a medical condition, which should be treated underneath the supervision of a medical doctor. Any adjustment to medication or prescriptions must be discussed with your supervising doctor. It is essential, therefore, for clients to obtain a referral letter before symptom-specific treatment can begin.
Further diagnosis details
Your doctor may ask to have further blood tests to test if you are anaemic and whether your illness has caused the level of protein to fall. In general, the greater the degree of anaemia and the lower the protein level, the more severe the inflammation is likely to be. Doctors also use special blood tests called ESR and CRP to give a measure of the degree of inflammation. You may be asked to give small samples of your bowel motions, to measure levels of faecal calprotectin, which is a marker of inflammation and to be sure there are no signs of any bowel infection.
Further microbiota details
In CD patients gut microbiome shifts, often these shifts include fewer bacteria in the Bacteroides and Lachnospiraceae groups (phyla), but more in the Proteobacteria and Actinobacteria groups (phyla). In addition, a decrease in a butyrate-producing bacterium, which is important in intestinal health, has been observed in patients with IBD. Therefore, researches around the world are exploring the efficacy and safety of FMT for CD patients including those patients who are unresponsive to current conventional therapy, such as anti-inflammatory agents, steroids, immune-suppressives, and biological therapies2.
Article Abstract 1:
Faecal Microbiota Transplantation for Inflammatory Bowel Disease: A Systematic Review and Meta-analysis.
J Crohns Colitis. 2017 May 9. doi: 10.1093/ecco-jcc/jjx063. [Epub ahead of print]
Faecal microbiota transplantation (FMT) has been investigated as a potential treatment for inflammatory bowel disease (IBD). We thus performed a systematic review and meta-analysis assessing the effectiveness and safety of FMT in IBD. A systematic review was conducted until Jan 2017. Studies were excluded if patients had co-infection or data was pooled across disease subtypes (ulcerative colitis (UC), Crohn’s disease (CD), pouchitis). Clinical remission was established as the primary outcome. Pooled effect sizes and 95% confidence intervals were obtained using the random effects model. 53 studies were included (41 in UC, 11 in CD, 4 in pouchitis). Overall, 36% (201/555) of UC, 50.5% (42/83) of CD and 21.5% (5/23) of pouchitis patients achieved clinical remission.