CHRONIC CONSTIPATION REVERSED BY RESTORATION OF BOWEL FLORA - A CASE AND A HYPOTHESIS

Objective: Treatment of chronic idiopathic constipation by alteration of bowel flora. Design: A single patient case report, describing pre- and post-therapy symptom and pathophysiology reversal following succes sful novel therapy. Setting: Outpatient Endoscopy Clinic. Patient: A 4 3-year-old woman with a 3-year history of constipation following uncom plicated hysterectomy, who had used a wide spectrum of laxatives. Inte rventions: The patient received oral vancomycin 250 mg three times dai ly for 4 weeks followed by bowel flora alteration involving enema infu sion over 2 consecutive days of faeces donated by her husband. Outcome measures: Symptoms were reported throughout treatment and follow-up p eriod. Colonoscopy with biopsy/histology and anorectal physiological s tudies were used before and 4 months after treatment. Results: Before treatment, stool frequency was once per week and investigations demons trated paradoxic sphincter contraction with visible and histological m elanosis coli on colonoscopy. During vancomycin treatment the constipa tion was reversed to clinical normality, and subsequent infusion of no rmal faeces resulted in prompt and long-term (18 months) resolution of symptoms. Follow-up manometric and histological studies were normal. Conclusion: It is hypothesized that the marked and sustained clinical reversal of signs and symptoms in this patient by a poorly absorbed or al antibiotic, and bowel flora alteration, may point to an intralumina l microbial origin for chronic idiopathic constipation.