Washed microbiota transplantation reduces proton pump inhibitor dependency in nonerosive reflux disease

Table 1 Basic information of patients with nonerosive reflux disease

Item	PPI	WMT	P value
Female	6	8
Age (median; IQR, yr)	58.5 (53, 67.25)	62 (55, 67)	0.526
Duration (median; IQR, mo)	48 (15, 144)	24 (6, 60)	0.218
BMI (median; IQR, kg/m2)	21.63 (19.13, 24.38)	24.24 (22.58, 25.43)	0.079

WMT: Washed microbiota transplantation; PPI: Proton pump inhibitors; BMI: Body mass index; IQR: Interquartile range.

Table 2 Symptom scores and remission time before and after treatment in the two groups

Group	PPI (n = 12)	WMT (n = 15)	P value1
Pre-GERDQ (median; IQR)	12 (9, 13.75)	12 (10, 12)	0.746
Post-GERDQ (median; IQR)	11 (8.25, 13.5)	7 (7, 8)	0.004
Intra-group, P value2	0.477	0.003
Pre-RDQ (median, IQR)	26 (18, 33)	23 (16, 25)	0.203
Post-RDQ (median, IQR)	20.5 (12.75, 26)	8 (6, 12)	0.003
Intra-group, P value	0.005	0.002
Remission time (median, IQR; mo)	2 (0, 4)	8 (3, 17)	0.002

¹The RDQ and GERDQ scores between two groups were analyzed by non-parametric Mann-Whitney test.

²The intra-group RDQ and GERDQ scores were analyzed by non-parametric Wilcoxon signed-rank test.

WMT: Washed microbiota transplantation; PPI: Proton pump inhibitors; RDQ: Reflux disease questionnaire; GERDQ: Gastroesophageal reflux disease questionnaire; IQR: Interquartile range.

Table 3 Clinical responses to washed microbiota transplantation in patients with nonerosive reflux disease

Item		WMT, n = 15
Remission1, n		14 (93.3)
Remission after the first course of WMT, n		13 (86.7)
Remission after the first course of FMT until the end of the study, n		10 (66.7)
No remission after the first course of WMT, n		2 (13.3)
Recurrence after remission, n		2 (13.3)
Side effects of WMT treatment2, n	No	14 (93.3)
	Yes	1 (6.70)

¹The scores of the reflux disease questionnaire or gastroesophageal reflux disease questionnaire at 1 mo post-washed microbiota transplantation (WMT) were reduced by 30%.

²Only one of the 15 patients had minor side effects, with a mushy stool two or three times a day, which resolved on their own after 1 wk, but no abdominal pain, black stool, fever, or serious WMT-related side effects were observed.

WMT: Washed microbiota transplantation; FMT: Fecal microbiota transplantation.

Table 4 Use of proton pump inhibitors in nonerosive reflux disease patients

Items		PPI	WMT
Continuous use before treatment (n)	No reduction after treatment	3	4
	Reduction after treatment	5	0
	Withdrawal after treatment	3	0
Usage as needed before treatment (n)	No reduction after treatment	0	4
	Reduction after treatment	2	2
	Withdrawal after treatment	2	2

WMT: Washed microbiota transplantation; PPI: Proton pump inhibitors.

Table 5 Results of examining the function of the intestinal mucosal barrier in the washed microbiota transplantation group

Item	Lipopolysaccharide	Diamine oxidase	D-lactate
Pre-treatment (median, IQR)	7.5 (3.6, 10.4)	4.1 (3.2, 6.5)	8.9 (7.6, 11.8)
Post-treatment (median, IQR)	10.1 (1.0, 23.6)	7.7 (2.3, 13.54)	16.3 (7.7, 18.3)
P value1	0.401	0.263	0.208

¹The results were analyzed by nonparametric Wilcoxon signed-rank test.

IQR: Interquartile range.