Introduction

To discuss a new surgical strategy: Tongji procedure (subtotal colectomy combined with modified Duhamel procedure), of which the indications, technical notes and outcomes were analyzed.

Aims & Methods

The 220 patients with refractory slow-transit constipation associated with outlet obstruction was strictly included between February 2019 and February 2023. The patients induded 60 males and 160 females. Their age were 18-80 years (average 46±14). The 198 patients received laparoscopic-assistant Jinling procedure, and 32 patients with open Jinling procedure. The pre- and post-operation data were collected. The follow up rate were 100%, 95.1%, 92.8% and 91.7% at 3, 6, 12 and 24 months.

Results

There was no surgery-related death. Mean hospital day was (8±1.5) days. Most complications were managed conservatively without significant events. The common complications after surgery were adhesive intestinal obstruction (3.2%), anastomosis bleeding (5.1%) and anastomosis leakage (3.9%). The gastrointestinal quality of life index score was 72±9 preoperatively and increased to 68±11, 99±6, 105±9, 106±9 at 3, 6, 12 and 24 month follow-up, respectively (t=62.1，-25.1，-126.5，-143.2，P<0.01). The Wexner constipation scale was 21.9±4.5 preoperatively and decreased to 9.6±2.4, 5.9±2.1, 4.6±1.9, 4.5±1.8 at 3, 6, 12 and 24 month follow-up, respectively (t=48.6, 61.8, 58.2, 45.9，P<0.01). The satisfactory rate was 77.5%, 92.1%, 93.0% and 94.1% at 3, 6, 12, and 24 month follow-up.

Conclusion

Tongji procedure provides a good surgical option for refractory slow-transit constipation associated with outlet obstruction.

Disclosure

NO

Introduction

To observe the long-term efficacy and complications of FMT in the treatment of diseases related to intestinal dysbiosis in China.

Aims & Methods

Collect clinical data of 15000 patients who received FMT treatment and were followed up for more than 3 months from May 2017 to September 2024; The inclusion criteria for cases are patients who meet the indications for FMT treatment; Among them, there were 8258 cases of constipation, 684 cases of CDI, 1730 cases of chronic diarrhea, 510 cases of inflammatory bowel disease, 432 cases of radiation enteritis, 1940 cases of irritable bowel syndrome, 365 cases of autism, 870 cases of postoperative gastrointestinal dysfunction, and 211 cases of neurodegenerative diseases. The treatment methods for intestinal microbiota transplantation include receiving continuous infusion of intestinal microbiota solution through the nasointestinal tube (into the jejunum) for 6 days after placement (upper gastrointestinal tract transplantation group), continuous oral administration of intestinal microbiota capsules for 6 days (oral capsule transplantation), and one-time injection of microbiota solution into the colon through colonoscopy (lower gastrointestinal tract transplantation group);The main observation indicators are the efficacy of intestinal microbiota transplantation treatment at 3, 12, and 36 months. The secondary outcome measures were the occurrence of short-term (within 2 weeks after treatment) and long-term (within 36 months after treatment) adverse reactions.

Results

A total of 15000 patients in the group were treated with upper gastrointestinal route in 11125 cases, oral capsule transplantation (oral capsule group) in 3597 cases, and lower gastrointestinal route in 278 cases. At 3, 12, and 36 months after treatment, the overall treatment efficacy rates were 71.8% (10763/15000), 64.4% (7600/11808), and 58.8% (3659/6218), respectively. The clinical improvement rates for constipation were 70.3% (5805/8258), 60.8% (3858/6345), and 56.5% (1894/3352), respectively. The clinical improvement rates for CDI were 85.8% (587/684), 72.3% (408/564), and 67.3% (218/324), respectively. The clinical improvement rates for chronic diarrhea were 81.0% (1401/1730), 78.1% (1198/1534), and 72.3% (633/876), respectively. The clinical improvement rates of intestinal diseases were 64.3% (328/510), 52.3% (249/476), and 46.6% (97/208), respectively. The clinical improvement rates of radiation enteritis were 77.3%, 65.4%, and 53.6%, respectively; The clinical improvement rates of the oral capsule group were 57.3% (2062/3597), 53.6% (1115/2081), and 45.0% (453/1006), respectively; The clinical improvement rates of the lower gastrointestinal pathway group in three time periods were 43.5% (121/278), 36.4% (48/132), and 14.9% (10/67), respectively. No serious adverse reactions occurred during treatment and follow-up. The most common adverse reactions in the upper gastrointestinal route group, oral capsule group, and lower gastrointestinal route group were respiratory discomfort (20.4%, 2269/11 125), nausea and vomiting during capsule swallowing (7.6%, 273/3597), and diarrhea (47.5%, 132/278), respectively; The above symptoms disappeared after the end of treatment. During a follow-up period of 36 months, 19 patients reported worsening of their pre-existing disease symptoms, 16 deaths were not directly related to FMT, and no abnormal systemic diseases were found after FMT.

Conclusion

FMT is effective in treating intestinal dysfunction and related extraintestinal diseases related to gut microbiota disorders in the long term, with no serious adverse events

References

• [1] Wang Y, Huang Y, Chase RC, et al. Global burden of digestive diseases: a systematic analysis of the global burden of diseases study, 1990 to 2019[J]. Gastroenterology, 2023, 165(3):773-783.e15. DOI: 10.1053/j.gastro.2023.05.050.
• [2] Fan Y, Pedersen O. Gut microbiota in human metabolic health and disease[J]. Nat Rev Microbiol, 2021, 19(1):55-71. DOI: 10.1038/s41579-020-0433-9.
• [3] Lynch SV, Pedersen O. The human intestinal microbiome in health and disease[J]. N Engl J Med, 2016, 375(24):2369-2379. DOI: 10.1056/NEJMra1600266.
• [4] Li YT, Cai HF, Wang ZH, et al. Systematic review with meta-analysis: long-term outcomes of faecal microbiota transplantation for Clostridium difficile infection[J]. Aliment Pharmacol Ther, 2016, 43(4):445-457. DOI: 10.1111/apt.13492.
• [5] Paramsothy S, Kamm MA, Kaakoush NO, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial[J]. Lancet, 2017, 389(10075):1218-1228. DOI: 10.1016/S0140-6736(17)30182-4.
• [6] Mincic AM, Antal M, Filip L, et al. Modulation of gut microbiome in the treatment of neurodegenerative diseases: a systematic review[J]. Clin Nutr, 2024, 43(7):1832-1849. DOI: 10.1016/j.clnu.2024.05.036.
• [7] Cammarota G, Ianiro G, Tilg H, et al. European consensus conference on faecal microbiota transplantation in clinical practice[J]. Gut, 2017, 66(4):569-580. DOI: 10.1136/gutjnl-2016-313017.

Disclosure

None

Introduction

Nearly 10% of Clostridium difficile infection (CDI) patients do not respond to fecal microbiota transplantation (FMT) treatment. Conducting clinical FMT studies to reveal microbiome characteristics of FMT-refractory patients is crucial for devising precise treatments for CDI, especially recurrent CDI (rCDI).

Aims & Methods

Twenty-three rCDI patients with parallel clinical baselines were recruited for FMT. Ten FMT donors meeting strict health standards were screened out from thousands of healthy people, and 171 stool samples were collected as healthy controls. Fecal samples were collected from 4 donors continuously for 25 weeks to evaluate the impact of microbiota fluctuation on FMT application.

Results

Seven of 23 patients didn’t respond to FMT treatment. The microbiome characteristics of non-remission patients showed significantly reduced α-diversity indexes. Butyrate-producing bacteria of the Firmicutes, including Bifidobacterium, Christensenellaceae_R_7_group, Ruminococcaceae_unclassified, Veillonella, Coprococcus_2, Fusicatenibacter, Oscillospira, and Roseburia, were almost completely depleted before treatment. Burkholderiales_unclassified, Coprococcus_2, and Oscillospira failed to colonize patient guts before and after treatment. Patients with good prognosis were characterized by a high relative abundance of Veillonella before treatment relative to its general depletion in patients with poor prognosis. Genera interactions in lower effectiveness FMT donors were more similar to those in non-remission patients, and Burkholderiales_unclassified, Coprococcus_2, and Oscillospira were frequently depleted in these donors. Older patients were not conducive to the colonization of Veillonella, consistent with their poor prognosis after FMT. rCDI patients with Crohn's disease were only found in the non-remission group.

Conclusion

rCDI patients with poor prognosis from FMT have characteristics unfavorable to Firmicutes butyrate-producing microbe colonization.

References

1. Hung YP, Lee JC, Lin HJ, Liu HC, Wu YH, Tsai PJ, Ko WC: Clinical impact of Clostridium difficile colonization. Journal of microbiology, immunology, and infection 2015, 48(3):241-248.
2. Buffie CG, Bucci V, Stein RR, McKenney PT, Ling L, Gobourne A, No D, Liu H, Kinnebrew M, Viale A et al: Precision microbiome reconstitution restores bile acid mediated resistance to Clostridium difficile. Nature 2015, 517(7533):205-208.
3. Bartlett JG, Gerding DN: Clinical recognition and diagnosis of Clostridium difficile infection. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2008, 46 Suppl 1:S12-18.
4. Singh H, Nugent Z, Yu BN, Lix LM, Targownik LE, Bernstein CN: Higher Incidence of Clostridium difficile Infection Among Individuals With Inflammatory Bowel Disease. Gastroenterology 2017, 153(2):430-438.e432.
5. Czepiel J, Dróżdż M, Pituch H, Kuijper EJ, Perucki W, Mielimonka A, Goldman S, Wultańska D, Garlicki A, Biesiada G: Clostridium difficile infection: review. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2019, 38(7):1211-1221.

Introduction

Functional constipation (FCon), a highly prevalent functional gastrointestinal disorder (FGID), often accompanies by mental and psychological disorders. Previous neuroimaging studies have demonstrated brain functional and structural alterations in FCon patients. However, little is known about whether and how regional homogeneity (ReHo) is altered in FCon patients. Moreover, the potential genetic mechanisms associated with these alterations remain largely unknown.

Aims & Methods

A total of 73 patients with FCon and 68 healthy controls were recruited, and we conducted ReHo comparison to identify the abnormal spontaneous brain activities in FCon patients. Based on Allen Human Brain Atlas, we further employed partial least squares regression analysis to explore gene expression profiles associated with ReHo alterations in FCon patients.

Results

Compared with healthy controls, FCon patients demonstrated significantly decreased ReHo in both bilateral caudate nucleus, putamen, anterior insula, thalamus and right middle cingulate cortex, supplementary motor area, and increased ReHo in the bilateral orbitofrontal cortex. Genes related to central nervous system development, fatty acid metabolism, and immunity were spatially correlated with abnormal ReHo patterns.
Table 1. The demographic and clinical characteristics of FCon and HC.

Conclusion

Our findings showed significant ReHo alterations in FCon patients, and these changes may be related to complex polygenetic and poly-pathway mechanisms, which provides a new perspective to understand the pathophysiology of FCon.

References

[1]Alame A M, Bahna H. Evaluation of constipation. Clin Colon Rectal Surg. Mar 2012;25(1):5-11.
[2]Drossman D A. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. Feb 19 2016.
[3]Black C J, Drossman D A, Talley N J, Ruddy J, Ford A C. Functional gastrointestinal disorders: advances in understanding and management. Lancet. Nov 21 2020;396(10263):1664-1674.
[4]Mugie S M, Benninga M A, Di Lorenzo C. Epidemiology of constipation in children and adults: a systematic review. Best Pract Res Clin Gastroenterol. Feb 2011;25(1):3-18.
[5]Barberio B, Judge C, Savarino E V, Ford A C. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. Aug 2021;6(8):638-648.
[6]Person H, Keefer L. Psychological comorbidity in gastrointestinal diseases: Update on the brain-gut-microbiome axis. Prog Neuropsychopharmacol Biol Psychiatry. Apr 20 2021;107:110209.
[7]Hosseinzadeh S T, Poorsaadati S, Radkani B, Forootan M. Psychological disorders in patients with chronic constipation. Gastroenterol Hepatol Bed Bench. Summer 2011;4(3):159-163.
[8]Martin B C, Barghout V, Cerulli A. Direct medical costs of constipation in the United States. Manag Care Interface. Dec 2006;19(12):43-49.

Introduction

Fecal microbiota transplantation (FMT) has been successfully used in a series of diseases in recent years. Most studies have focused on short-term risks, which are mild and generally associated with delivery methods. There have been no reports of FMT safety in the treatment of multiple diseases and long follow-up periods.

Aims & Methods

We performed a retrospective analysis of 11025 patients who underwent FMT in the Tenth People’s Hospital of Tongji University between January 2012 and December 2023. We included patients with various gastrointestinal diseases and patients with extraintestinal diseases that involved intestinal dysfunction. A questionnaire was administered to the included patients during follow-up (2 weeks, 3 months, 1 year, and 5 years after FMT) via telephone and health portal software Haodaifu app).

Results

Most adverse events during short-term follow-up (2 weeks) were related to the method of delivery. The main adverse events in the nasogastric tube group were tube-related respiratory difficulty (40.6%,include sore throat 14.1%, nasal congestion 8.7%, nasal irritation due to nasogastric intubation 17.8%) and nausea/vomiting (12.6%). In the oral capsules group, nausea and vomiting (8.9%) occurred during oral administration because the capsules are associated with a fecal smell and taste, both of which are difficult to remove completely. For colonoscopy and enema routes, the main adverse events were diarrhea (10.7%, 9.9%) and perianal discomfort (15.3%, 8.4%), respectively. Two cases in the colonoscopy group and one case in the enema group were complicated with colon perforation, but remission with conservative treatment. The most frequently reported adverse events were mild or moderate in severity and transient. Those symptoms associated with nasogastric tube administration disappeared after tube removal at the completion of treatment. Several other new symptoms were reported during short-term follow-up, although none occurred in >1% of patients. The most common symptom reported was bloating/flatulence. Although more adverse events were reported in the nasogastric tube group, most were mild. Additionally, patients are more comfortable with the upper gastrointestinal route because they could use it for enteral nutrition support or gastrointestinal imaging according to their medical needs. Based on our clinical experience, we proposed the “Tongji FMT Requirements”and implemented them in our clinic (beginning in 2019) to standardize the indications and timing of FMT treatment and to improve FMT safety. After the implementation of these requirements for 2 years, we compared safety data collected before and after implementation; The application of the requirements has effectively reduced adverse events. The short-term (mainly FMT-related diseases) incidence rate significantly decreased from 32.6% in 2017–2019 to 17.2% in 2019–2021.

Table 1.Tongji FMT Requirements

Conclusion

FMT appears safe during both short-term and long-term follow-up. The patient group that received FMT did not exhibit an increased incidence of new diseases, and the risk of infection transmission appears to be low. Considering the widespread use of FMT, there is a need for the establishment of a national clinical and patient-reported FMT safety collection system in future.

References

• 1) Kelly CR, Yen EF, Grinspan AM, et al. Fecal microbiota transplantation is highly effective in real-world practice: initial results from the fmt national registry. Gastroenterology 2021;160:183-192
• 2) Mullish BH, Quraishi MN, Segal JP, et al. The use of faecal microbiota transplant as treatment for recurrent or refractory clostridium diffificile infection and other potential indications: Joint british society of gastroenterology (BSG) and healthcare infection society (HIS) guidelines. Gut 2018;67:1920e41
• 3) Saha S, Mara K, Pardi DS, et al. Long-term Safety of Fecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection. Gastroenterology 2021;160:1961-1969
• 4) Zhang S, Chen Q, Kelly CR, et al. Donor Screening for Fecal Microbiota Transplantation in China: Evaluation of 8483 Candidates. Gastroenterology 2022;162:966-968
• 5) Parenteral and Enteral Nutrition Branch of Chinese Medical Association, et al. Chinese experts consensus on standardized methodology and clinical application of fecal microbiota transplantation. Zhonghua Wei Chang Wai Ke Za Zhi 2020;23:5-13
• 6) Wang S, Kou C, Liu Y, et al. Rural-urban differences in the prevalence of chronic disease in northeast China. Asia Pac J Public Health 2015;27:394-406

Introduction

Chronic constipation is a prevalent gastrointestinal complaint with increasing incidence among the aging population. Examining colonoscopy performance in chronic constipation across age groups, this study aims to comprehensively assess diagnostic yield and compare results with average-risk controls.

Aims & Methods

A retrospective analysis was conducted on 50,578 colonoscopy procedures performed over 12 years, including 5,478 constipated patients. An average-risk control group (n=4,100) was included. Data extracted from electronic medical records covered demographics, operational aspects, and colonoscopy findings. The primary outcome measures included the diagnosis rate of colorectal cancer (CRC), polyp detection rate (PDR) and inflammatory bowel disease (IBD) diagnoses in constipated patients versus controls, with age-based and multivariate analyses.

Results

Constipated patients exhibited lower rates of adequate bowel preparation (92.7% vs. 85.3%; p < 0.001) and a lower cecal intubation rate. No significant variances between CRC and PDR were observed between constipated and controls, except for a potential of a slightly elevated CRC risk in constipated patients older than 80 (2.50% vs. 0% in controls; p = 0.07). However, multivariate analysis demonstrated that constipation did not confer an increased risk for CRC or polyp detection across all age groups. Notably, younger constipated patients exhibited a higher rate of IBD diagnoses (1.7% vs. 0.1% in controls; p < 0.001).

Conclusion

Conclusion: Constipation did not confer an increased risk for CRC or polyps among all age groups, except for a potential signal of elevated CRC risk in patients older than 80, and was associated with higher rates of IBD in younger patients.

References

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2. Camilleri M, Brandler J. Refractory Constipation: How to Evaluate and Treat. Gastroenterol Clin North Am. 2020 Sep;49(3):623-642.
3. Shahini E, Sinagra E, Vitello A, Ranaldo R, Contaldo A, Facciorusso A, Maida M. Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients: Evidence from the literature. World J Gastroenterol. 2023 Mar 21;29(11):1685-1707.
4. Mahmood S, Farooqui SM, Madhoun MF. Predictors of inadequate bowel preparation for colonoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2018;30:819–826.
5. Hassan C, East J, Radaelli F, Spada C, Benamouzig R, Bisschops R, et al. Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019. Endoscopy. 2019 Aug;51(8):775-794.
6. Włodarczyk J, Waśniewska A, Fichna J, Dziki A, Dziki Ł, Włodarczyk M. Current Overview on Clinical Management of Chronic Constipation. J Clin Med. 2021 Apr 16;10(8):1738.
7. James SL, van Langenberg DR, Taylor KM, Gibson PR. Characterization of ulcerative colitis-associated constipation syndrome (proximal constipation). JGH Open. 2018 Aug 5;2(5):217-222.