Alimentary Pharmacology and Therapeutics Invited Editorials
Editorial: a simple faecal preparation for faecal microbiota transplantation – authors’ reply R. Satokari*, E. Mattila†, V. Kainulainen* & P. E. Arkkila‡ *Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland. † Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland. ‡ Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland. E-mail: reetta.satokari@helsinki.fi doi:10.1111/apt.13045
We thank Dr C.R. Kelly for her interest and comments on our work and her balanced view on the use of faecal microbiota transplantation (FMT) for recurrent Clostridium difficile infection (rCDI).1 We agree with Dr Kelly’s views in general and would like to discuss some specific issues further. In our paper, we describe a simple protocol for preparing donor faeces, which facilitates some practical aspects of FMT.2 In faecal preparation and storage, we used 80 °C freezer, which allows quick freezing. We have not tested standard freezers for this purpose and cannot exclude the possibility that the viability of microbiota is compromised by freezing and storing at 20 °C. Considering the route of administration, we used infusion into caecum in colonoscopy, because we had previously good experience of this method in treating rCDI patients.3 As pointed out by Dr Kelly, FMT via sigmoidoscopy would be easier and less costly as compared with colonoscopy. However, there are only few small scale studies comparing the treatment efficacy of FMT via different routes of administration and further studies are
Editorial: showing due DILI-gence – the lessons from anabolic steroids J. Neuberger Queen Elizabeth Hospital, Birmingham, UK. E-mail: [email protected] doi:10.1111/apt.13048
The diagnosis of drug-induced liver injury (DILI) continues to pose challenges for clinicians: virtually all forms of liver damage may be induced by drugs, from mild disAliment Pharmacol Ther 2015; 41: 320-324 ª 2015 John Wiley & Sons Ltd
warranted. It is still difficult to conclude what would be the optimal route of administration considering all aspects of FMT. In our study, the follow-up period was 12 months, which is longer than in most other studies. The 1-year success rate of FMT treatment for rCDI was 88% and the treatment was found to be safe.1 Previously, Kelly et al. have demonstrated FMT to be a safe treatment for rCDI also in immunocompromised patients.4 Clearly, the short-term (up to 1 year) benefits of FMT outweigh the observed harms. However, we completely agree with Dr Kelly that further studies are needed to address the long-term health implications of FMT. In clinical work, experienced physicians should make the decision on using FMT by considering and balancing both the short-term benefits and possible long-term risks.
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Kelly CR. A simple fecal preparation protocol for faecal microbiota transplantation. Aliment Pharmacol Ther 2015; 41: 320. 2. Satokari R, Mattila E, Kainulainen V, Arkkila PE. Simple faecal preparation and efficacy of frozen inoculum in faecal microbiota transplantation for recurrent Clostridium difficile infection - an observational cohort study. Aliment Pharmacol Ther 2015; 41: 46–53. 3. Mattila E, Uusitalo-Sepp€al€a R, Wuorela M, et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology 2012; 142: 490–6. 4. Kelly CR, Ihunnah C, Fischer M, et al. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol 2014; 109: 1065–71.
turbance of liver tests though acute hepatitis to fulminant hepatic failure, to chronic hepatitis and cirrhosis, tumours (benign and malignant), granulomatous disease and vascular disease. Furthermore, one agent may be associated with more than one pattern of liver damage. Early recognition is important since, in most cases, withdrawal will usually result in improvement and will reduce the risk of re-exposure. The diagnosis is essentially one of exclusion and is made clinically on the basis of history with a clear relationship between use of the drug and onset of damage, pattern recognition, symptoms, serological, radiological and histologic features. 321
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Editorial: a simple faecal preparation for faecal microbiota transplantation – authors’ reply R. Satokari*, E. Mattila†, V. Kainulainen* & P. E. Arkkila‡ *Department of Veterinary Biosciences, University of Helsinki, Helsinki, Finland. † Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland. ‡ Department of Gastroenterology, Helsinki University Central Hospital, Helsinki, Finland. E-mail: reetta.satokari@helsinki.fi doi:10.1111/apt.13045
We thank Dr C.R. Kelly for her interest and comments on our work and her balanced view on the use of faecal microbiota transplantation (FMT) for recurrent Clostridium difficile infection (rCDI).1 We agree with Dr Kelly’s views in general and would like to discuss some specific issues further. In our paper, we describe a simple protocol for preparing donor faeces, which facilitates some practical aspects of FMT.2 In faecal preparation and storage, we used 80 °C freezer, which allows quick freezing. We have not tested standard freezers for this purpose and cannot exclude the possibility that the viability of microbiota is compromised by freezing and storing at 20 °C. Considering the route of administration, we used infusion into caecum in colonoscopy, because we had previously good experience of this method in treating rCDI patients.3 As pointed out by Dr Kelly, FMT via sigmoidoscopy would be easier and less costly as compared with colonoscopy. However, there are only few small scale studies comparing the treatment efficacy of FMT via different routes of administration and further studies are
Editorial: showing due DILI-gence – the lessons from anabolic steroids J. Neuberger Queen Elizabeth Hospital, Birmingham, UK. E-mail: [email protected] doi:10.1111/apt.13048
The diagnosis of drug-induced liver injury (DILI) continues to pose challenges for clinicians: virtually all forms of liver damage may be induced by drugs, from mild disAliment Pharmacol Ther 2015; 41: 320-324 ª 2015 John Wiley & Sons Ltd
warranted. It is still difficult to conclude what would be the optimal route of administration considering all aspects of FMT. In our study, the follow-up period was 12 months, which is longer than in most other studies. The 1-year success rate of FMT treatment for rCDI was 88% and the treatment was found to be safe.1 Previously, Kelly et al. have demonstrated FMT to be a safe treatment for rCDI also in immunocompromised patients.4 Clearly, the short-term (up to 1 year) benefits of FMT outweigh the observed harms. However, we completely agree with Dr Kelly that further studies are needed to address the long-term health implications of FMT. In clinical work, experienced physicians should make the decision on using FMT by considering and balancing both the short-term benefits and possible long-term risks.
ACKNOWLEDGEMENT The authors’ declarations of personal and financial interests are unchanged from those in the original article.2 REFERENCES 1. Kelly CR. A simple fecal preparation protocol for faecal microbiota transplantation. Aliment Pharmacol Ther 2015; 41: 320. 2. Satokari R, Mattila E, Kainulainen V, Arkkila PE. Simple faecal preparation and efficacy of frozen inoculum in faecal microbiota transplantation for recurrent Clostridium difficile infection - an observational cohort study. Aliment Pharmacol Ther 2015; 41: 46–53. 3. Mattila E, Uusitalo-Sepp€al€a R, Wuorela M, et al. Fecal transplantation, through colonoscopy, is effective therapy for recurrent Clostridium difficile infection. Gastroenterology 2012; 142: 490–6. 4. Kelly CR, Ihunnah C, Fischer M, et al. Fecal microbiota transplant for treatment of Clostridium difficile infection in immunocompromised patients. Am J Gastroenterol 2014; 109: 1065–71.
turbance of liver tests though acute hepatitis to fulminant hepatic failure, to chronic hepatitis and cirrhosis, tumours (benign and malignant), granulomatous disease and vascular disease. Furthermore, one agent may be associated with more than one pattern of liver damage. Early recognition is important since, in most cases, withdrawal will usually result in improvement and will reduce the risk of re-exposure. The diagnosis is essentially one of exclusion and is made clinically on the basis of history with a clear relationship between use of the drug and onset of damage, pattern recognition, symptoms, serological, radiological and histologic features. 321
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
