Centre for Digestive Diseases Five Dock, New South Wales, Australia
Anoja W. Gunaratne, BAMS, MSc, PhD, Annabel K. Clancy, BSc, APD, PhD, Portia Murphy, BSc, Thomas J. Borody, MD, PhD, DSc, FACG Centre for Digestive Diseases, Five Dock, New South Wales, Australia
Introduction: Ankylosing spondylitis (AS) is an autoimmune disease which causes inflammatory arthritis in the spine and sacroiliac joints. Symptoms of AS include back pain, stiffness and reduced mobility in the spine. Patients with AS are known to have subclinical gut wall inflammation and dysbiosis in the gut. There is no known treatment to cure AS. Here, we report incidental improvement in AS in two patients with irritable bowel syndrome predominant diarrhoea (IBS-D) who received faecal microbiota transplant (FMT).
Case Description/Methods: Case one:
Female, 47 years of age, with known IBS-D, presented with recurrent abdominal pain, explosive diarrhoea 5 time a day, nocturnal bowel motions and urgency. At the same time, she was on salazopyrin and arava for her AS with limited improvement in symptoms. Stool testing was for positive Clostridium difficile toxin and she received 2 fresh FMT’s (one via colonoscopy, one via enema) in 2016. Testing 1 month after FMT treatment was negative to Clostridium difficile toxin. The patient had no ongoing gastrointestinal (GI) symptoms. She also reported significant improvement in AS symptoms (specifically reduction in excruciating pain in lower back and hip).
After five years, her IBS-D symptoms relapsed and she had another 2 FMTs (one via colonoscopy, one via enema) which resulted in improvements in GI symptoms and more improvement in AS than previous FMTs. Her CRP and ESR levels were normal pre and post treatment.
Case two:
Male, 68 years of age, with known IBS-D received fresh 2 FMTs (one via colonoscopy, one via enema) in 2005 for treatment of IBS-D. Prior to treatment he had abdominal pain, cramps and loose motion and AS symptoms including excruciating pain in the sacroiliac joint. He was on infliximab and analgesics for his AS. After FMT treatment, he reported resolution of all GI symptoms and AS symptoms. His pre and post CRP levels were 100 and 2.6 and ESR levels were 18 and 7 respectively.
In 2009, he had antibiotic treatment for sinusitis and his GI symptoms relapsed. He had a further 5 FMTs, again with complete recovery of GI symptoms and continued AS remission.
Discussion: We observed short-term and long-term improvement in AS symptoms after treating patients with FMT. Future prospective trials are required to confirm FMT as a treatment for AS.
Disclosures:
Anoja Gunaratne: Centre for Digestive Diseases – Employee.
Annabel Clancy: Centre for Digestive Diseases – Employee.
Portia Murphy: Centre for Digestive Diseases – Employee.
Thomas Borody: Axent medical Pty. Ltd – Advisory Committee/Board Member. Centre for Digestive Diseases – Advisory Committee/Board Member, Consultant, Employee, Grant/Research Support, Intellectual Property/Patents, Ownership interest, Owner/Ownership Interest, Stock-privately held company. Finch Therapeutics – Advisory Committee/Board Member, Intellectual Property/Patents, Stock-publicly held company(excluding mutual/index funds). Topelia Therapeutics – Advisor or Review Panel Member, Intellectual Property/Patents.
Anoja W. Gunaratne, BAMS, MSc, PhD, Annabel K. Clancy, BSc, APD, PhD, Portia Murphy, BSc, Thomas J. Borody, MD, PhD, DSc, FACG. D0275 - Ankylosing Spondylitis Improved Following Faecal Microbiota Transplantation: Two Case Reports, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
