Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3786-3796
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3786
Awareness and attitude of fecal microbiota transplantation through transendoscopic enteral tubing among inflammatory bowel disease patients
Min Zhong, Yang Sun, Hong-Gang Wang, Cicilia Marcella, Bo-Ta Cui, Ying-Lei Miao, Fa-Ming Zhang
Min Zhong, Cicilia Marcella, Bo-Ta Cui, Fa-Ming Zhang, Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Min Zhong, Cicilia Marcella, Bo-Ta Cui, Fa-Ming Zhang, Key Lab of Holistic Integrative Enterology, Nanjing Medical University, Nanjing 210011, Jiangsu Province, China
Yang Sun, Ying-Lei Miao, Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Yunnan Institute of Digestive Disease, Kunming 650032, Yunnan, China
Hong-Gang Wang, Medical Center for Digestive Diseases, The Affiliated Huaian No. 1 People’s Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Author contributions: Zhang FM designed the study; Zhong M designed the survey and drafted the manuscript; Zhang FM, Cui BT and Marcella C were involved in revision of the manuscript; Zhong M, Sun Y, Wang HG, Marcella C and Miao YL were responsible for the data acquisition; Zhong M conducted the statistical analyses.
Supported by Jiangsu Province Creation Team and Leading Talents Project (to Zhang FM).
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of The Second Affiliated Hospital of Nanjing Medical University.
Informed consent statement: The study was a survey of patients’ perceptions using questionnaires. Patients were asked if they would like to complete the questionnaire before starting to fill it out. They would only complete the questionnaire if they wanted to. There was no risk to the participants, and no individual patient information was revealed under the condition of anonymity.
Conflict-of-interest statement: Zhang FM invented the concept of transendoscopic enteral tubing and related devices. All other authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items and the manuscript was prepared and revised accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fa-Ming Zhang, MD, PhD, Director, Professor, Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, No. 121 Jiangjiayuan, Nanjing 210011, Jiangsu Province, China. fzhang@njmu.edu.cn
Received: March 26, 2020
Peer-review started: March 26, 2020
First decision: April 26, 2020
Revised: April 28, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: September 6, 2020
Research background

Fecal microbiota transplantation (FMT) has shown its therapeutic potential in inflammatory bowel disease (IBD). Transendoscopic enteral tubing (TET) has been used in China as a safe and convenient procedure for multiple FMTs and colonic medication administration with a high degree of satisfaction among adult patients.

Research motivation

A new clinical therapeutic application depends not only on its efficacy but also on the recognition and attitudes of physicians and patients.

Research objectives

The main objectives of this study were to explore the recognition and attitudes of FMT through TET in patients with IBD and the preference of FMT delivery.

Research methods

An anonymous questionnaire was distributed among IBD patients in two provinces of Eastern and Southwestern China. The participants were divided into two groups: (1) Group 1: Patients without experience of FMT; and (2) Group 2: Patients with experience of FMT. We also evaluated their awareness and attitudes toward FMT and TET and their preference of FMT delivery.

Research results

Nearly half of the IBD patients were unaware that FMT was a therapeutic option, and a large proportion of patients did not know the concept of TET prior to this survey. Mass media and physician’s recommendation were the most common sources of information. Patients’ choice for the delivery of FMT was affected by the type of disease and whether the patient had experience with FMT. Crohn’s disease patients in Group 2 were more likely to choose mid-gut TET than patients in Group 1. Meanwhile, for ulcerative colitis patients, Group 2 had a larger proportion of patients who preferred colonic TET than Group 1. The relevant analysis showed that patients in Group 2 were more likely to recommend FMT than those in Group 1. The type of disease was an independent factor influencing the recommendations of TET. Ulcerative colitis patients were more likely to recommend TET than Crohn’s disease patients.

Research conclusions

IBD patients have a low awareness of FMT and TET in China. If awareness about FMT and TET increases, then a more positive attitude will be exhibited toward FMT, thus showing the significance of education to patients.

Research perspectives

Further studies need to clarify the patients’ attitude to the washed microbiota transplantation, which has been regarded as the new technology of FMT.