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

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Disclosure

None

Introduction

Acute non-variceal upper gastrointestinal bleeding (NVUGIB) is a common emergency with high morbidity and mortality. Lactate levels and comorbidity indices, such as the Charlson Comorbidity Index (CCI), have shown promise in predicting patient outcomes. While these parameters individually provide valuable prognostic insights, their collective utility in predicting mortality among NVUGIB patients has not been explored.

Aims & Methods

The data for this study were collected from hospital records of patients admitted to Hitit University Hospital with NVUGIB between June 2021 and June 2024.
Demographic information, including age, gender, chronic illnesses, current medications, and history of previous gastrointestinal bleeding, was retrieved from computer database. Clinical data, such as outcomes (discharge or death), reasons for mortality, length of hospital stay were documented. Laboratory parameters, including lactate levels were recorded. Additionally, CCI and Glasgow Blatchford Score (GBS) were calculated for each patient.
Patients were stratified based on mortality status, which was considered the primary outcome. The associations between mortality and potential predictive factors were statistically analyzed. To improve mortality prediction, parameters that were significant in the logistic regression analysis were combined and assessed independently.

Results

A total of 390 patients with acute upper gastrointestinal bleeding were initially assessed. Of these, 180 patients were excluded due to missing data, leaving 210 patients included in the final study cohort. Key variables such as age, CCI, GBS, length of hospital stay, and mortality status were presented. Laboratory findings upon admission and the etiological distribution of gastrointestinal bleeding sources were also detailed.
Variables significantly associated with mortality in the univariate analysis include age, CCI, GBS, urea, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and lactate levels. In the logistic regression analysis, significant predictors of mortality were CCI (OR: 1.318, p=0.001) and lactate levels (OR: 1.575, p=0.003). GBS was not a predictor for mortality (p=0.468). CCI plus lactate levels were significantly higher in deceased patients compared to survivors (12.96 vs.7.31, p<0.001).
The correlation coefficients (r) showed significant positive correlations between the combination of lactate levels and CCI with GBS (r=0.498, p<0.001), length of stay (r=0.213, p=0.014), age (r=0.634, p<0.001) and urea levels (r=0.417, p<0.001). No significant correlation was found with AST or ALT.
ROC curves for lactate levels, CCI and CCI plus lactate levels predicting mortality showed that the area under the curve (AUC) for lactate was 0.704 (95% CI: 0.577–0.830, p=0.002) with a cut-off value of 1.83, yielding a sensitivity of 76% and a specificity of 52%. For CCI, the AUC was 0.769 (95% CI: 0.670–0.869, p<0.001) with a cut-off value of 6.5, showing a sensitivity of 76% and a specificity of 70%. And for the ‘CCI plus lactate’ level, the AUC was higher as 0.799 (95% CI: 0.703–0.895, p<0.001) with a cut-off value of 8.3, showing a sensitivity of 88% and a specificity of 62%.

Conclusion

Both lactate levels and the CCI are valuable tools for predicting mortality in NVUGIB patients. Our findings support the use of these parameters collectively to improve risk stratification. Combining lactate levels and CCI offers the advantage of better predicting mortality and improving sensitivity compared to using lactate levels or CCI alone.

Introduction

Despite its widespread use, the benefit of pre-endoscopic fresh frozen plasma (FFP) transfusion in acute upper gastrointestinal bleeding (AUGIB) with mild to moderate coagulopathy remains unproven. Current guidelines are inconsistent, and indiscriminate use of FFP—particularly in patients with variceal bleeding—may expose patients to harm without improving outcomes.

Aims & Methods

To assess the impact of pre-endoscopic FFP transfusion on clinical outcomes, including 30-day mortality, in patients with AUGIB and an INR between 1.5 and 2.5. We conducted a multicenter retrospective cohort study at one university-affiliated and one tertiary care hospital in Thailand between January 2016 and December 2020. Adult patients with AUGIB and INR 1.5–2.5 were included. Patients were stratified into FFP and non-FFP groups based on transfusion prior to endoscopy. Multivariable logistic regression was performed to adjust for age, comorbidities, bleeding etiology, and hemodynamic parameters. Subgroup analysis was conducted in patients with variceal bleeding.

Results

Among 244 patients (158 FFP; 86 non-FFP), those receiving FFP had significantly higher in-hospital mortality (24.1% vs. 7.0%; p = 0.001), pulmonary edema (23.4% vs. 4.7%; p < 0.001), and longer hospital stay (mean 8.1 vs. 5.8 days; p < 0.001). After adjustment, FFP transfusion remained independently associated with in-hospital mortality (adjusted OR 5.65; 95% CI 2.13–14.99; p < 0.001) and pulmonary edema (adjusted OR 5.56; 95% CI 1.59–19.44; p = 0.007). In patients with variceal bleeding, the adverse effect of FFP was more pronounced. The adjusted 30-day mortality was higher in the FFP group (adjusted OR 2.38; p = 0.075), though this did not reach statistical significance.

Conclusion

Pre-endoscopic FFP transfusion in AUGIB patients with INR 1.5–2.5 is associated with increased risk of in-hospital mortality and volume-related complications, particularly in variceal bleeding. These findings support a more selective and individualized transfusion approach and challenge the routine use of FFP in this population. Prospective studies are warranted to validate these observations and guide evidence-based transfusion thresholds.

References

1. Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. Am J Gastroenterol. 2021 May 1;116(5):899-917.
2. Beattie C, Chakravarthy M. Fresh Frozen Plasma. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554919/
3. de Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C; Baveno VII Faculty. Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-974.