Purpose: CFS is both difficult to diagnose and to treat due to its complex and multifactorial etiology. CFS is considered an exclusionary diagnosis in the absence of known etiological causes such as hyperthyroidism and anaemia, and is characterised by persistent (>6 months) disabling fatigue¹. Bacterial and viral species have been known to trigger CFS symptoms such as EBV, B. burgdorferi, Coxiella and Brucella, species. Current inadequate symptom-specific therapies include cognitive behavioural therapy and graded exercises. We previously reported 40% improvement in a sub-group of constipation-predominant IBS patients with CFS². These findings led to speculation of an enteric flora-derived bacterial etiology in CFS. Here we review a larger cohort who had undergone bacteriotherapy for CFS, with long-term follow up.
Methods: A total of 60 patients presented with CFS (52 IBS-CFS, 4 Constipation-CFS, 4 CFS) (36F, 24M m: 55 +/- 11.5yrs). 5/60 CFS patients received a single transcolonoscopic (TC) infusion of 300cc culture comprising 13 non-pathogenic enteric bacteria [Bacteroidetes, Clostridia, E coli]. 52/60 patients underwent 2 day infusion (TC and rectal infusion) while 3/60 underwent three day rectal infusion schedule (TC and 2 day rectal infusion). Response/non-response was defined as a resolution/return of CFS symptoms (sleep deprivation, lethargy/fatigue) at 4 week follow-up.
Results: 35/60 patients responded to initial bacteriotherapy treatment. 10/15 patients who failed initial bacteriotherapy were offered a secondary TC infusion and either; follow up rectal infusion (n=4) or an oral course of cultured bacteria (n=6). Of these 7/10 responded to therapy. Hence a total of 42/60 (70%) patients achieved clinical response post bacteriotherapy and of this 37/42 also experienced resolution of associated gastrointestinal (GI) symptoms. Of 18 nonresponders, 10 attained associated GI symptom improvement despite persisting CFS symptoms. At 15-20yr follow-up 12/60 patients were contactable and 7/12 (58%) remains CFS-free. 5/12 experienced CFS recurrence approx 1.5-3 years post bacteriotherapy.
Conclusion: Bacteriotherapy achieves initial success rate of 70% in CFS and 58% sustained response. This result is favourable when compared with current therapies where fewer than 10% recover fully and a further 10%-20% worsen during follow-up¹. Given that manipulation of the colonic microbiota improved CFS symptoms, bacteriotherapy for CFS warrants further investigation. Furthermore, the pathophysiology of CFS could be in part explained by enteric derived toxin-releasing bacteria capable of producing systemic effects. 1. Afari N and Buchwald D. Am J Psychiatry 2003; 160:221-236 2. Borody TJ. Presented at the CFS National Consensus Conference, 1995. Sydney.

Disclosures: Thomas J Borody has a pecuniary interest in the Centre for Digestive Diseases and has filed patents in this area.

Citation: . BACTERIOTHERAPY IN CHRONIC FATIGUE SYNDROME (CFS): A RETROSPECTIVE REVIEW. Program No. P362. ACG 2012 Annual Scientific Meeting Abstracts. Las Vegas, NV: American College of Gastroenterology.