J Neurogastroenterol Motil  
Serial Frozen Fecal Microbiota Transplantation in the Treatment of Chronic Intestinal Pseudo-obstruction: A Preliminary Study
Lili Gu, Chao Ding, Hongliang Tian, Bo Yang, Xuelei Zhang, Yue Hua, Yifan Zhu, Jianfeng Gong, Weiming Zhu, Ning Li* and Jieshou Li
Jinling Hospital, Research Institute of General Surgery, Nanjing University School of Medicine, Nanjing, China
Correspondence to: Ning Li, PhD
Jinling Hospital, Research Institute of General Surgery, Nanjing University School of Medicine, No. 305 East Zhongshan Road, Nanjing 210002, China
Tel: +86-025-80860089, Fax: +86-025-80860089, E-mail: liningrigsnju@163.com
Received: May 15, 2016; Revised: October 9, 2016; Accepted: October 13, 2016; Published online: November 11, 2016.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Chronic intestinal pseudo-obstruction (CIPO) is a serious, life-threatening motility disorder that is often related to bacterial overgrowth. Fecal microbiota transplantation (FMT) results in restoration of the normal intestinal microbial community structure. We investigated the efficacy of FMT in the treatment of CIPO patients.
Methods
Nine patients (age 18-53 years) with CIPO were enrolled in this prospective, open-label study. Patients received FMT for 6 consecutive days through nasojejunal (NJ) tubes and were followed up for 8 weeks after treatment. We evaluated the rate of clinical improvement and remission, feeding tolerance of enteral nutrition, and CT imaging scores of intestinal obstruction. Lactulose hydrogen breath tests were performed before FMT and 8 weeks after FMT to evaluate for the presence small intestinal bacterial overgrowth (SIBO).
Results
FMT significantly alleviated bloating symptoms, and symptoms of pain were relieved 2 weeks after FMT. Enteral nutrition administered through a NJ tube after FMT was well-tolerated by 66.7% (6/9) of patients. CT scores of intestinal obstruction were significantly reduced after FMT (P = 0.014). SIBO was eliminated in 71% (5/7) of patients.
Conclusions
This pilot study demonstrated the safety of using FMT. FMT may relieve symptoms in selected patients with CIPO. FMT may also improve patient tolerance of enteral nutrition delivered via a NJ tube.
Keywords: Intestinal pseudo-obstruction; Fecal microbiota transplantation; Tolerance of enteral nutrition


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