Year 2025 / Volume 117 / Number 12
Original
Fecal microbiota transplantation for prevention of recurrent acute cholangitis. Review of four published cases

725-729

DOI: 10.17235/reed.2025.11404/2025

Antonio Ramos Martínez, Andrea Gutiérrez-Villanueva, Mariano González-Haba Ruiz, Itziar Diego-Yagüe, Alberto Nieto-Fernández, Elena Muñez, Ana Fernández Cruz, Jorge Calderón Parra,

Abstract
Introduction: recurrent acute cholangitis (RAC) constitutes a relevant clinical problem that may condition the prognosis of the patient. Chronic suppressive antibiotic therapy can be used for preventive purposes, but it is associated with adverse effects and can select resistant bacterial strains. Fecal microbiota transfer (FMT) has been shown to be effective to prevent recurrent Clostridioides difficile infection and could be a useful strategy in patients with RAC. Objective: to review the experience of the use of FMT in the prevention of episodes of RAC by reviewing published cases. This article is based on previously published cases without presenting new original clinical data. Result: four cases were identified in which FMT significantly reduced RAC episodes. The patients were characterized by lack of efficacy of conventional treatments, had different predisposing factors for RAC and frequent colonization and infection by multidrug-resistant bacteria. Conclusions: the four cases presented provide limited but encouraging evidence of the preventive effect of FMT on successive episodes in patients without biliary tract obstruction. Larger and more adequately designed studies will be necessary to deepen the knowledge of this possible preventive strategy.
Lay Summary
Recurrent acute cholangitis (RAC) is a serious infection of the bile ducts that often comes back in some patients. These repeated infections can lower a person’s quality of life and may even be life-threatening. Standard treatments usually involve antibiotics, but over time, these can stop working and may lead to antibiotic-resistant bacteria. This article explores a new and promising approach: fecal microbiota transplantation (FMT). FMT involves transferring healthy gut bacteria from a donor into the patient’s digestive system. It has already been proven effective to treat another type of infection caused by Clostridioides difficile. The authors reviewed four published cases where FMT was used to prevent RAC. These patients had different medical backgrounds but had all been treated with traditional treatments that had failed to stop the infection. After receiving FMT, all four patients experienced fewer or no new episodes of cholangitis for several months. In some cases, the treatment also helped reduce harmful bacteria in the gut and improved liver function. Below is a summary of the four cases: - One patient with a rare liver disease had no new infections for a year after FMT. - An elderly patient stopped having RAC for several months without evidence of resistant bacteria - A female with a complex surgical history remained infection-free for over two years. - A 93-year-old male avoided new infections for 15 months after taking FMT capsules. While these results are encouraging, the authors caution that more research is needed. The number of patients is small, and the methods used (such as how FMT was given) varied. Even so, these cases suggest that restoring healthy gut bacteria might help prevent bile duct infections in some individuals. In conclusion, FMT could be a valuable tool for patients with RAC who don’t respond to standard treatments. However, it should only be used in clinical trials or under medical supervision until more evidence is available.
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References
1. Almirante B, Pigrau C. Colangitis aguda. Enfermedades Infecc Microbiol Clínica. 2010 Sep;28:18–24.
2. Pérez-Calvo JI, Olivera-González S, Amores-Arriaga B, Torralba-Cabeza MA. Antibioterapia cíclica en colangitis aguda bacteriana recurrente en pacientes no quirúrgicos. Rev Clínica Esp. 2009 Apr;209(4):204–5.
3. Li K, Hu X, Lu Q, Zhang H, Zhou J, Tian S, et al. Analysis of Pathogenic Bacteria Distribution and Related Factors in Recurrent Acute Cholangitis. Infect Drug Resist. 2023 Jul;Volume 16:4729–40.
4. Bu LN, Chen HL, Chang CJ, Ni YH, Hsu HY, Lai HS, et al. Prophylactic oral antibiotics in prevention of recurrent cholangitis after the Kasai portoenterostomy. J Pediatr Surg. 2003 Apr;38(4):590–3.
5. Metwally O, Man K. The role of endoscopy in the management of recurrent pyogenic cholangitis: a review. J Community Hosp Intern Med Perspect. 2015 Jan;5(4):27858.
6. Muñoz L, Borrero M, Úbeda M, Conde E, Del Campo R, Rodríguez‐Serrano M, et al. Intestinal Immune Dysregulation Driven by Dysbiosis Promotes Barrier Disruption and Bacterial Translocation in Rats With Cirrhosis. Hepatology. 2019 Sep;70(3):925–38.
7. Tripathi A, Debelius J, Brenner DA, Karin M, Loomba R, Schnabl B, et al. The gut-liver axis and the intersection with the microbiome. Nat Rev Gastroenterol Hepatol. 2018 Jul;15(7):397–411.
8. van Nood E, Vrieze A, Nieuwdorp M, Fuentes S, Zoetendal EG, de Vos WM, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med. 2013 Jan 31;368(5):407–15.
9. Ramos-Martínez A, Martínez-Ruiz R, Múñez-Rubio E, Valencia-Alijo A, Ferre-Aracil C, Vera-Mendoza MI. Effect of faecal microbiota transplantation on recurrent urinary tract infection in a patient with long-term suprapubic urinary catheter. J Hosp Infect. 2020 Jun;105(2):332–3.
10. Biehl LM, Cruz Aguilar R, Farowski F, Hahn W, Nowag A, Wisplinghoff H, et al. Fecal microbiota transplantation in a kidney transplant recipient with recurrent urinary tract infection. Infection. 2018 Dec;46(6):871–4.
11. Jeney SES, Lane F, Oliver A, Whiteson K, Dutta S. Fecal Microbiota Transplantation for the Treatment of Refractory Recurrent Urinary Tract Infection. Obstet Gynecol. 2020 Oct;136(4):771–3.
12. Philips CA, Augustine P, Phadke N. Healthy Donor Fecal Microbiota Transplantation for Recurrent Bacterial Cholangitis in Primary Sclerosing Cholangitis – A Single Case Report. J Clin Transl Hepatol. 2018 Sep 28;6(xx):1–4.
13. Gouveia C, Palos C, Pereira P, Roque Ramos L, Cravo M. Fecal Microbiota Transplant in a Patient Infected with Multidrug-Resistant Bacteria: A Case Report. GE - Port J Gastroenterol. 2021;28(1):56–61.
14. Scott A, Khoruts A, Freeman ML, Beilman G, Ramanathan K, Bellin MD, et al. Successful Use of Fecal Microbiota Transplantation in Management of Nonobstructive Recurrent Cholangitis Following Total Pancreatectomy and Islet Autotransplant. ACG Case Rep J. 2024 Oct;11(10):e01527.
15. Ramos-Martínez A, Múñez E, Del-Campo R, Nieto-Fernández A, Gonzalez-Haba M, Calderón- Parra J. Fecal microbiota transplantation as a preventive treatment for recurrent acute cholangitis. IDCases. 2024;37:e02025.
16. Marangoni G, Ali A, Faraj W, Heaton N, Rela M. Clinical features and treatment of sump syndrome following hepaticojejunostomy. Hepatobiliary Pancreat Dis Int. 2011 Jun;10(3):261–4.
17. Brown KA, Langford B, Schwartz KL, Diong C, Garber G, Daneman N. Antibiotic Prescribing Choices and Their Comparative C. Difficile Infection Risks: A Longitudinal Case-Cohort Study. Clin Infect Dis. 2021 Mar 1;72(5):836–44.
18. Mullish BH, Quraishi MN, Segal JP, McCune VL, Baxter M, Marsden GL, et al. The use of faecal microbiota transplant as treatment for recurrent or refractory Clostridium difficile infection and other potential indications: joint British Society of Gastroenterology (BSG) and HealthRACe Infection Society (HIS) guidelines. Gut. 2018 Nov;67(11):1920–41.
19. Wahlström A, Sayin SI, Marschall HU, Bäckhed F. Intestinal Crosstalk between Bile Acids and Microbiota and Its Impact on Host Metabolism. Cell Metab. 2016 Jul 12;24(1):41–50.
20. Zheng D, Liwinski T, Elinav E. Interaction between microbiota and immunity in health and disease. Cell Res. 2020 Jun;30(6):492–506.
21. Allegretti JR, Kassam Z, RACrellas M, Mullish BH, Marchesi JR, Pechlivanis A, et al. Fecal Microbiota Transplantation in Patients With Primary Sclerosing Cholangitis: A Pilot Clinical Trial. Am J Gastroenterol. 2019 Jul;114(7):1071–9.
22. Ferstl PG, Bremer K, Filmann N, Kempf VAJ, Hogardt M, Ballo O, et al. Short Versus Long Antibiotic Therapy and Risk of Recurrence of Acute Cholangitis Due to Malignant Biliary Strictures. J Clin Med. 2023 Oct 24;12(21):6716.
23. Hasegawa M, Sanmoto Y. Recurrent cholangitis and bacteraemia due to Edwardsiella tarda : a case report. Oxf Med Case Rep. 2024 Jan 1;2024(1):omad148.
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Ramos Martínez A, Gutiérrez-Villanueva A, González-Haba Ruiz M, Diego-Yagüe I, Nieto-Fernández A, Muñez E, et all. Fecal microbiota transplantation for prevention of recurrent acute cholangitis. Review of four published cases. 11404/2025


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Publication history

Received: 10/06/2025

Accepted: 25/06/2025

Online First: 04/07/2025

Published: 12/12/2025

Article Online First time: 24 days

Article editing time: 185 days


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