Case Reports
First Case Report of Fecal Microbiota Transplantation in a Cat in
IsraelFurmanski, S.1, * and Mor, T.2
12

Medi-Vet Veterinary Hospital, 8 Einstein St., Haifa 3460506, Israel.
Veterinary Endoscopic Services, 2 Reuven Rubin St., Tel Aviv 6941253, Israel.

* Corresponding Author: Dr. Shirley Furmanski, B.Sc, DVM, Dipl. ABVP (C/F), Medi-Vet Veterinary Hospital, 8 Einstein St., Haifa 3460506, Israel.
Phone: +972-4-834-2887. Email: shirley.furmanski@gmail.com

AB S T RAC T

This case report describes a 10-year-old, 2.9 kg, female spayed Abyssinian cat diagnosed with ulcerative
colitis (UC), unresponsive to conventional therapy. A fecal microbiota transplantation (FMT) through rectal(enema) administration was performed as a last therapeutic option for the cat before euthanasia, and there
was an immediate improvement after the procedure in regards to fecal texture, odor and color. After the initial
successful response, the cat developed a clinical relapse of the diarrhea, and a second FMT procedure was
performed five weeks thereafter. Gradually, during a 3-month period the cat started passing normal stools. On
a follow-up, 11 months into the procedure, a prolonged clinical cure of the diarrhea has been achieved withthe cat passing normal feces. This report describes the criteria for choosing FMT for the cat, the selection
process and the screening tests performed for the fecal donor for infectious bacterial and parasitic diseases,
the preparation and the methodology for the FMT and the outcome of the procedure. According to ourclinical assessment, in this cat, FMT was a safe, beneficial and promising novel therapeutic procedure, andshould be considered when a patient fails to respond to conventional therapy for UC. To the best of theauthors’ knowledge this is the first report of FMT in a cat performed in Israel.
Keywords: Cats; Feline; Fecal Microbiota Transplantation; Ulcerative Colitis; Inflammatory
Bowel Disease; Fecal Donor Selection; Dysbiosis; Clostridium difficile.

Chronic diarrhea of numerous etiologies is a common frustrating disorder in cats (1, 2). Chronic colitis is characterized
by large-bowel diarrhea with frequent defecation of small
volumes of soft to watery stool, often mixed with mucus
and hematochezia (3, 4). Feline lymphoplasmacytic colitis is
the most common form described, followed by eosinophilic,
neutrophilic, granulomatous and ulcerative colitis (UC) (2,3, 5). The exact etiology is unknown, and may be different
between feline patients, but it is widely accepted that thepathogenesis of colitis involves complex interplay of hostgenetics, intestinal mucosal immune system, environment,
and intestinal microbiota (3, 4, 6).

Many conventional and newly introduced therapeuticmeasures of enteropathies have been described in the veterinary literature. Fecal Microbiota Transplantation (FMT)
is one of a newly emerged novel targeted microbiome-based
therapy for gastrointestinal diseases, which has received
considerable attention in human medicine (7, 8), as well as
in veterinary medicine (9-11).
FMT is the introduction of fecal suspension, obtained
from a selected healthy individual (donor), into the gastrointestinal tract (GIT) of an ill patient (recipient), mostcommonly suffering from GIT disease characterized predominantly by dysbiosis (12, 13). FMT is being carried out
commonly in humans and is effective for treating Clostridium

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difficile infection (CDI) unresponsive to antibiotics (7, 14,15) as well as for non-GIT disorders (8). FMT has been
carried out for many decades in animals, including horses,
cattle and monkeys (9), as well as in cats and dogs with avariety of chronic enteropathies (1, 10, 11, 13). However,in contrast to the extensive studies of the use and efficacyof FMT in humans, information in dogs and cats is very
limited, comprising mainly of anecdotal reports and a few
case series (1, 10, 11, 13).
The rationale of using FMT in humans and animals issimilar to the rationale of using prebiotics, probiotics or their
combination (i.e., synbiotics), with their potential to modify
and improve the intestinal microbiota and affecting the host’s
immune response (8, 16). It has been hypothesized that, inhumans, FMT restores the colonic normal microbial community structure, thereby protecting against colonization ofpathogenic bacteria such as Clostridium difficile, and suppressing its growth and its production of disease-causing toxins.
However, the exact mechanism leading to the restorationof intestinal function is incompletely understood (8). Thishypothesis is supported by evidence of the beneficial effects ofintestinal microorganisms on health, and by the observation,in humans, that an FMT recipient can adopt, restore andmaintain the transplanted microbiota (7, 15). Supportive evidence of the protective role of the microbiota was describedin a recent case-series of three dogs with chronic enteropathy,
where the microbiota analysis (i.e., ‘dysbiosis index’; DI) was
assessed prior to and after FMT. The results suggested correlations between the DI values and the absence, presence or
improvement of the clinical signs of diarrhea (13).
Currently, there are no pre-set consensus guidelines regarding performance of FMT in dogs and cats. Veterinarians
may consider FMT when other, conventional therapeutic
options of GIT disorders have failed (17, 18). Studies incats and dogs have demonstrated the potential to improvevarious acute and chronic GIT disorders, including inflammatory bowel disease (IBD), colitis and idiopathic diarrhea(10, 11, 13). Similar alterations in small intestinal and fecal
microbial populations in dysbiosis observed in human IBD orin animal models of intestinal inflammation associated withdysbiosis, suggests that the microbial responses to intestinal
inflammation are similar across different mammalian species(13, 19-21).
This report describes FMT in a cat with chronic diarrhea,
unresponsive to conventional therapy.

A 10-year-old, 2.9 kg, female spayed Abyssinian cat diagnosed on histopathology with ulcerative colitis (UC),unresponsive to conventional therapy for over one year, waspresented for FMT procedure as the last therapeutic option
before euthanasia. The cat was currently vaccinated and dewormed. It had queened several times in the past, and shortly
after the last two parturitions and prior to being spayed,transient self-limiting diarrhea was noted. In addition, twice
previously, and 5 years prior to the onset of chronic mucoid
large-bowel bloody diarrhea, giardiasis and Tritrichomonas
foetus were detected by direct fecal wet mount-smears. The cat
was treated with metronidazole (Flagyl Suspension, Unither
Liquid Manufacturing, Colomiers, France; 20 mg/kg BID
PO for 7 days) and Ronidazole (compounded by Vetmarket,
Shoham, Israel; 30 mg/kg BID for 10 days), respectively,
which led to resolution of the diarrhea in both episodes.
Six months before the cat was diagnosed with UC, signsof bloody, mucoid and malodorous large-bowel diarrhea werenoted. Repeated complete blood counts, serum biochemistry profiles, direct fecal smears and fecal flotations overthe period from onset of the clinical signs of large bowel
diarrhea to the FMT were unremarkable. Serology for feline leukemia virus (FeLV) and feline immunodeficiency
virus (FIV) (FeLV Antigen/FIV Antibody Test Kit, SNAP*
Combo Plus, IDEXX Laboratories, Westbrook, ME, USA)
were negative. Total serum T4 (VetScan VS2, Abaxis Inc.,
Global Diagnostics, Union City, CA, USA) was within reference interval (RI). A gastrointestinal parasitic and infectious
agents’ screen (Laboratory Animal Department, American
Medical Laboratories, Herzliya Pituach, Israel) was negative.
Serum cobalamin and folate concentrations were within their
RIs. Biopsies obtained via enteroscopy and colonoscopy weresent for histopathology (Patho-Vet Diagnostic Veterinary
Pathology Services, Rehovot, Israel). The microscopic findings in the colonic biopsies included extensive ulceration andloss of the mucosal architecture, with numerous bacterialcolonies and food material on the ulcerated mucosal surface(Figure 1). In one section, moderate diffuse infiltration withmacrophages was noted. Biopsies obtained from the distal
small intestines were unremarkable. PAS stain was performed
for the endoscopic biopsies. There was no evidence of positive
staining of macrophages infiltrating – the ulcerated colon.
The findings were compatible with severe ulcerative colitis.

Furmanski, S.

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Figure 1: Extensive ulceration and loss of the mucosal architecturein the colon with moderate diffuse infiltration with macrophages(H&E X40).

The cat was then treated with multiple oral medications,
at times combined, for varying periods, including metronidazole (Flagyl, Unither Liquid Manufacturing, Colomiers,
France; 15 mg/kg BID, sulfamethoxazole/trimethoprim(compounded by Vetmarket, Shoham, Israel; 15 mg/kg BID),
prednisone (Rekah Pharmaceuticals, Holon, Israel; 2 mg/kg
BID, then tapered to 1 mg/kg BID), maropitant (Cerenia,
Fareva, Amboise, France; 1 mg/kg SID for 5 days and thentwice a week), sulfasalazine (compounded by Vetmarket,
Shoham, Israel; 10 mg/kg TID), mirtazapine (compounded
by Vetmarket, Shoham, Israel; 2 mg SID), ranitidine (Aspen,
Bad Oldesloe, Germany; 2.2 mg/kg BID), chlorambucil(Leukeran, Excella GmbH, Feucht, Germany; 2 mg every 3days administered late in the disease course) and cobalamin(Bedodeka, Teva, Godollo, Hungary; 250 µg subcutaneously(SC) every 7 days for 6 weeks, and then every 30 days forseveral months).
The diet had been changed during this period. The
diets included a high fiber diet (canned Hill’s Prescription
Diet feline w/d, Hill’s Pet Nutrition, Topeka, KS, USA), an
intestinal diet (canned Hill’s Prescription Diet feline i/d,
Hill’s Pet Nutrition, Topeka, KS, USA) and a hypoallergenic
diet (canned Hill’s Prescription Diet feline z/d, Hill’s Pet
Nutrition, Topeka, KS, USA). The latter had been fed for thelast 3 months prior to the FMT, and thereafter. Dietary fibers(Psyllium 95% and Fusidic acid powder, Rafa, Jerusalem,
Israel; 1 teaspoon SID-BID with food) and probiotics(Florentero paste, Candioli Pharma, Turin, Italy; 1 mL SID
PO) were also given but were discontinued 4 months before
the first FMT. Despite the chronic large bowel diarrhea, theIsrael Journal of Veterinary Medicine  Vol. 72 (3)  September 2017

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cat did not lose weight and had a good appetite throughout
the disease course. However, as there was no improvement
in response to any of the above mentioned treatments overa 12-month period, the owner had considered euthanasia.
It was at this stage that the FMT was scheduled as a novel
microbiome-based therapeutic technique for UC. The cat was
taken off all medications 7 days before the FMT.
The donor used in this case was a healthy 3-year-old,
6.2 kg, female spayed domestic shorthair cat, with a body
condition score (BCS) of 5/9 with no history of gastrointestinal disease, which was currently vaccinated and routinely
dewormed. The donor cat did not have a history of a recent(past 3 months) antibiotic use, and the only antibiotic use
was at time of being spayed at 6 months of age. The donor
cat was fed a commercial dry adult cat (Friskies, PurinaNestle, Vevey, Switzerland). Serology for FIV and FeLV wasnegative. Direct fecal smear and floatation were negative forworms, egg worms, Giardia spp. and other protozoa and fecal

Figure 2: (A) The donor feces was passed through a strainer; (B) A
slurry of the fecal suspension with no visible large particles; (C) The
administration of the 30 mL fecal cocktail via a lubricated 8 FR 2-way
standard balloon Foley catheter which was introduced rectally andgently advanced until it reached the estimated location of the transverse
colon while the anus held closed by an assistant. The recipient cat wasplaced in right lateral recumbency with its caudal body slightly elevated.
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cultures were negative for Campylobacter spp., Salmonella
spp., Clostridium difficile spp. and common aerobic bacterial
pathogens (Kimron Veterinary Institute, Beit Dagan, Israel).
It was necessary to synchronize between the collection of
the donor’s fresh fecal sample and the essential preparation of
the recipient cat. Immediately before the FMT procedure, afresh (still warm and moist) fecal sample was obtained fromthe fecal donor. The donor cat was hospitalized and fasted
the night before FMT. The stool was obtained through a
direct removal of feces from the donor’s rectum while thedonor cat was slightly sedated, and the donor cat was doing
well thereafter.
Five grams of the donor’s stool was then diluted at a 1:6
ratio with a non-bacteriostatic sterile saline solution at room
temperature, and mixed manually and then by blender. Largeparticles in the suspension were filtered through a strainer(Figure 2A), yielding a large particle-free slurry (Figure 2B).
The 30 mL fecal slurry to be administered was transferred toa 60 mL catheter-tip sterile syringe to which was attached
the 8 FR 2-way standard sterile balloon silicone-coated 100%
latex Foley catheter.
The recipient cat was fasted overnight before the FMT
procedure. At presentation, it was bright, alert and responsive,with normal vital signs. Physical examination was unremarkable. Its BCS was 3/9. It had a bloody, mucoid and malodorous diarrhea (Figure 3A). Once the donor stool sample wasobtained, the recipient cat was premedicated (medetomidine;
Domitor, Orion Pharma, Espoo, Finland; 10 µg/kg IM, butorphanol; Butomidor, Richter Pharma AG, Wels, Austria;
0.2 mg/kg IM and midazolam; Midolam, Rafa Laboratories,
Jerusalem, Israel; 0.3 mg/kg IM). With sedation, approximately 15 minutes later, a 23 G over-the-needle IV catheter
was placed into the left cephalic vein, and general anesthesia
was induced with propofol (Diprofol; Synthon Hispania SL,

Barcelona, Spain; 2 mg/kg IV to effect), and maintained with
isoflurane (Piramal Critical Care, Bethlehem, PA, USA) and
100% oxygen (2 L/min) delivered via an endotracheal tube.
During anesthesia lactated Ringer’s solution (Teva Medical,
Ashdod, Israel; 5 mL/kg IV) was administered. The cat was
stable throughout the procedure.
The recipient cat was placed in right lateral recumbency
with its caudal body slightly elevated. A warm water enema
was administered via a lubricated 8 FR 2-way standard balloon catheter attached to a 60 mL catheter-tip syringe,
pre-filled with warm water (to avoid introduction of air into
the colon), introduced up to the estimated location of thetransverse colon. Immediately after the enema, the donor’s
fecal slurry was administered via a lubricated 8 FR 2-way
standard balloon Foley catheter which was introduced rectallyand gently advanced until up to the estimated location of thetransverse colon (Figure 2C). Some of the fecal slurry was
pushed into the catheter prior to its administration into thecat, to avoid introducing air into the colon. A total volume of
30 mL (10 mL/kg body weight) were administered slowly,
while the anus held closed by an assistant. No discomfort signs
were noted. It took 35 minutes from the beginning of the
preparation of the fresh donor stool and until the prepared
fecal slurry was fully administered. After completing the FMT
infusion, the recipient was kept in right lateral recumbency for
15 additional minutes, and was then placed in sternal position
for another 15 minutes, and then in left lateral recumbency
for additional 15 minutes (total retention period of 45 minutes). The cat recovered uneventfully from the anesthesia, wasobserved in hospitalization for 6 hours, was fasted, and its
activity was restricted, to decrease the likelihood of prematurebowel movements. The cat was then discharged. A hypoallergenic diet (canned Hill’s Prescription Diet feline z/d, Hill’s
Pet Nutrition Inc., Topeka, KS, USA) was prescribed.

Figure 3: (A) The recipient (bloody, mucoid and malodorous) stool immediately before the FMT procedure; (B) The recipient stool 48 hours
after FMT: soft with no evidence of blood; (C) The recipient stool 4 days after FMT: stool with normal texture and color.

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Over the first 24 hours post-FMT a bloody diarrhea wasnoted. At 48 hours post-FMT the stool was soft with noevidence of blood (Figure 3B) and over the next 2 days fecal
consistency gradually improved. On day 4 post-FMT thecat passed a stool with normal texture and color for the firsttime after over a year (Figure 3C). After several additionaldays loose stool was noted again. Five weeks post-FMT no
substantial fecal texture improvement was noted, while occasional fresh blood and mucus were noted as well. A second
FMT was scheduled, and performed as described above, using
the same donor, using 6 grams of feces. No medications were
given between the two FMTs, and the cat was fed exclusively
the same hypoallergenic diet. On the day of the second FMT,
the recipient cat was bright, alert and responsive with normalvital signs, and weighed 2.7 kg. The cat recovered uneventfully
from the anesthesia, and discharged home on the same day.
No immediate improvement in fecal texture and consistency
was noted immediately after the second FMT procedure.
One month post-FMT, in a phone follow-up, the ownerreported some inconsistent improvement in fecal texture,color and odor. Sometimes the stool was loose and every
once in a while it was more formed with occasional fresh
blood and mucus noted. Three months after the second FMT
procedure, the owner reported that the cat had been passing
normal stool consistently. At the last recheck, 11 months after
the second FMT, the owner reported that the cat was doing
well and passing normal stools. During the whole period
from the second FMT procedure and until the 11-monthfollow-up, the cat was not treated with medications and was
fed exclusively the same hypoallergenic diet.
This report describes the use of FMT for the treatment of
UC unresponsive to conventional therapy in a cat. Althoughno accepted guidelines or protocol of FMT in dogs and cats
are available, the present favorable response to FMT as wellas previously published preliminary results in dogs and cats
(9-11, 13) are encouraging, suggesting that FMT is a safe andeffective procedure, and should be considered in selected unresponsive cases of chronic diarrhea. More research is needed
to determine the exact donor fecal components which playa role and exert a beneficial effect of FMT in the recipients.
In human medicine, FMT protocols vary in the quantityof used donor stool, the recipient preparation, donor stool
infusion methods and assessment of the outcome (7, 22, 23).

The methodology of the present FMT was adapted from therecommendations and experience published in the veterinary
literature in FMT treatment of chronic enteropathy (1, 10,
11, 17, 18) as well as recommendations in humans (7, 20,
22, 24).
The approach to fecal donor selection is variable and has
been evolving, and while the selection process characteristics
are undetermined, the present reported method was aimed
to adhere to available recommendations (1, 10, 11, 17, 18)
and standardize the different and multiple parameters of theprocedure. Nevertheless, certain limitations were encounteredregarding the donor’s screening process. The Giardia antigen
ELISA was unavailable at the time and Giardia was screened
for by fecal direct wet mount-smear and centrifugation flotation, which have a lower sensitivity. In addition, a special
request was made for the outside laboratory for isolation of
Clostridium difficile, although its presence in the gastrointestinal tract of dogs (4, 21) and cats (21, 24) is often a part of
the normal intestinal microbiota and is detected with similarfrequency in the feces of healthy and diarrheic dogs and cats
(4, 21, 24).
Furthermore, there are several different techniques
for preparing the donor’s feces infusion for FMT, and theamount of donor stool used varies (23,25). In this case, ahuman protocol describing the fecal infusion was adapted(22), as it was recommended previously for dogs and cats
(17, 18). However, this protocol suggested using ~50 gramsof feces with ~250 mL of normal saline, while presently,
5 and 6 grams of fresh donor stool (approximately 2 g/kg
body weight) were used in the two FMTs respectively. The
amount of fresh feces used in FMT procedure is limitedby the amount of fresh feces that can be obtained from thedonor cat immediately before the FMT. It is recommended
to avoid any delay when using fresh feces, because delay
exposes the fresh feces to air, which presumably could resultin progressive loss of some anaerobic microbiotal components
which may be important components in the normal desired
microbiota (17). In addition, there is conflicting evidence
regarding the volume of infusion. Various volumes of fecal infusions have been used in humans (23, 25). A recent
study has suggested low volume enema FMT is effective andsafe in human patients with chronic relapsing CDI (25).
However, a systematic review of FMT for treating recurrent CDI in humans has concluded that the resolution rateincreased with the volume of donor fecal infusion to 97%

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when the volume was >500 mL vs. 80% when <200 mL wasinfused (7). Although larger volume may be beneficial, by
allowing the clinician to deposit multiple aliquots in multiple
locations in the GIT, it might correspondingly increase thelikelihood of straining in the recipient, resulting in rapid
post-transplantation defecation (17).
In this case, the FMT was administered as rectal 30 mL
fresh fecal enema (1, 17). In humans, both fresh and frozen
preparations for FMT have been successfully used in managing recurrent CDI, introduced orally or rectally (15, 23). A
recent study has reported the use of frozen donor stool stored
at -80°C was equally beneficial compare to fresh donor stool(22). Using frozen feces preparations is more convenient thanfresh stool since it is not necessarily tied to the timing of
FMT procedure (17). In addition, the use of frozen stool
allows standardization of the calculated stool volume to be
used based on the recipient’s body weight. However, since
the preparation, storage and shipment of frozen feces is more
complex and time consuming, and is definitely of greater cost,currently, until centralized stool banks become available inveterinary medicine, it is probably more feasible to performthe FMT with fresh stools for dogs and cats.
A recent collaborative analysis of 305 individual humanpatient data from 14 studies has revealed that FMT delivered
via the lower GIT is a more effective route for the preventionof the recurrence of CDI compared to FMT delivered via theupper GIT route (12), although no similar evidence-based
data in the veterinary literature is available.
In this case, two FMT procedures were performed, five
weeks apart. Patients with confirmed chronic enteropathy,
such as IBD and UC, may show improved stool quality
several days to a weak post FMT, but the clinical signs may
relapse and therefore more than one FMT procedure might
be required to achieve sustained clinical cure (1, 10, 13). Withno consensus protocol, no specific recommendations regarding the frequency and time interval of the FMTs can bepresently made in animals, although it may be useful to repeat
the FMT every 3-4 weeks in some animals, to improve theclinical signs (10, 13). The recurrence of clinical signs in thiscat after their initial improvement after the first FMT mightsuggest recurrent dysbiosis due to the underlying UC. Thishypothesis might be supported by the results of a recent small
case-series that evaluated three dogs with a history of chronicenteropathy treated by FMT via nasoduodenal tube, in which
the fecal microbiota was evaluated using the DI. A DI was

calculated for each fecal sample using quantitative PCR
analysis. While the DIs drastically dropped to the donor-likevalue after the FMT procedure in all three dogs, implying
improvement of the dysbiosis, in three weeks, the DI of oneof the dog increased. This was correlated with the recurrenceof diarrhea, suggesting that in the future, the DI may be used
as a quick screening tool for GIT dysbiosis and disease. In
addition to fecal parasite and microbial pathogens screening,
DI may be used to monitor the intestinal microbiota before
and after FMT (13). Furthermore, molecular methods forcalculating microbial DIs will potentially lead to a better
understanding of the pathophysiology of GIT diseases, andnecessitate new diagnostic and therapeutic approaches fordysbiosis (26).
The correlation between the prolonged clinical remission
in the cat after the second FMT and the period of time until
improvement of fecal color and consistency was noted, can be
attributed to the process of normalization of GI dysbiosis, by
restoring the colonic normal microbial community structure
and its effect on the host’s immune response (13). Currently,
since the information regarding FMT in dogs and cats isvery limited and comprising mainly of anecdotal reports
and a few case series with no comprehensive studies, there
is no available data regarding the considerable time it may
take to notice an improvement in the clinical signs and inrestoring gastrointestinal homeostasis after the FMT. In
addition, a stool consistency score to directly evaluate the
FMT outcome was not used in this case, and should be usedin future FMTs in order to get a more precise, objective
and better quantitative evaluation of the feces described by
the owner. Further well-designed studies about the role ofmicrobiota and FMT treatment using a larger scale of higher
numbers of cats with more intestinal biopsies and fecal PCR
for DI before and after each FMT as well as multiple donors
are needed to help in better evaluating the role of FMT invarious enteropathies and disease processes and not just as
the last resource when other treatment options have been
exhausted (13).

Furmanski, S.

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CONCLUSIONS

Although this is a single clinical case report, the favorable
outcome post FMTs which resulted in a prolonged clinicalcure for the cat, suggests that FMT is a promising novel
therapy in chronic non-responsive enteropathies in cats, failing conservative therapy, and supports performing further

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22. Hamilton, M.J., Weingarden, A.R., Sadowsky, M.J. and Khourts,
A.: Standardized frozen preparation for transplantation of fecal microbiota for recurrent Clostridium difficile infection. Am. J.
Gastroenterol. 107:761-767, 2012.
23. Brandt, L.J. and Aroniadis, O.C.: An overview of fecal microbiotatransplantation: techniques, indications, and outcomes. Gastroenterol. Endosc. 78:240-249, 2013.
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25. Silverman, M.S., Davis, I. and Pillari, D.R.: Success of selfadministered home fecal transplantation for chronic Clostridium
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Israel Journal of Veterinary Medicine  Vol. 72 (3)  September 2017

Fecal Microbiota Transplantation

studies. The technique offers a safe and effective treatment
with a potentially favorable outcome.
Nevertheless, currently, there are limited evidence-based
objective data in the veterinary literature regarding therecommended protocol and guidelines for FMT. Further research is therefore necessary to clarify and evaluate microbialchanges as a consequence of FMT and to study the immune
and metabolic changes as an outcome of this procedure.
Furthermore, dogs and cats may serve as models to study
this therapeutic approach to spontaneous inflammatory conditions of the gastrointestinal tract in humans.
REFERENCES

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