Fecal Microbiota Transplant for Patients With Chronic Pouchitis

This study is testing whether fecal microbiota transplantation (FMT) — transferring stool from a healthy donor into a patient's gut — can effectively treat chronic pouchitis, a recurring inflammatory condition that affects people who have had their colon removed for ulcerative colitis and have had a pouch created from the small intestine. Pouchitis causes diarrhea, urgency, pain, and significant reduction in quality of life. It is often difficult to control with antibiotics and represents a major ongoing complication in this patient population. Adults aged 18 and older with ulcerative colitis who have undergone total proctocolectomy with ileal pouch-anal anastomosis (IPAA) and have chronic antibiotic-dependent pouchitis, chronic antibiotic-refractory pouchitis, or Crohn's disease-like pouch inflammation with persistent symptoms despite medical therapy are eligible. Patients currently on biologics (for antibiotic-dependent or antibiotic-refractory types), active enteric infections, who are pregnant or breastfeeding, or have allergies to study medications are not eligible. Participants will receive FMT and be assessed for remission of pouchitis symptoms and endoscopic findings. This research is important because pouchitis significantly undermines the benefit of having had surgery and can even threaten the pouch itself. FMT, which has revolutionized treatment for recurrent Clostridioides difficile infection, represents a promising and biologically rational approach to rebalancing the altered microbiome in these patients and potentially achieving sustained remission.