Fecal Bacteriotherapy for Ulcerative Colitis in Children

The great success of fecal bacteriotherapy, or fecal microbial transplant (FMT), for people with recurrent C. difficile infection has researchers investigating this treatment for other digestive diseases, most notably ulcerative colitis. A recent study published in the Journal of Pediatric Gastroenterology & Nutrition is the first to study this treatment in children and young adults with ulcerative colitis.1

“Colonic dysbiosis contributes to the development of colonic inflammation in ulcerative colitis (UC). Fecal microbial transplantation is being proposed as a novel treatment for UC as it can eliminate dysbiosis,” state the researchers. “We believe that the procedure may restore ‘normal’ in patients with UC. Our short-term study looked at the safety and tolerability of FMT for these patients.”

In the study, 10 patients aged 7 to 21 years with UC received daily fecal enemas for five days. In seven of the nine subjects who completed the treatment, 78 percent showed improvement within one week. Sixty-seven percent maintained the improvement after four weeks (the duration of the study). Thirty-three percent achieved clinical remission (remission is when all disease activity clears up) after one week of FMT.

“Patients often face a tough choice between various medications that have significant side effects. Allowing the disease to progress can lead to surgical removal of their colon,” stated Sachin Kunde, MD, MPH, pediatric gastroenterologist. “Our study showed that fecal enemas were feasible and well-tolerated by children with UC.”

The results of this study, although good, do not quite reach the 90+ percent effectiveness as seen in C. diff studies that administer the FMT via colonoscope, which delivers the transplant further into the colon. Also, I would be interested to learn the longer-term outcome of this study. Do these children remain improved or in remission three or six months later?

Researchers are still trying to figure out the best way to administer FMT. The authors of this study noted, “We must further investigate standardization of FMT preparation, ideal donor selection, the best route of administration, and optimal duration or scheduling of FMT to induce and maintain a clinical response.”

I believe our best bet will be a super probiotic, similar to the one used in the RePOOPulate study I blogged about recently, in which an array of beneficial bacteria are included that have been screened and selected for optimal survival and health benefits.2 I look forward to more studies on this topic, and I will share them as they emerge.

 

References

  1. S. Kunde, et al., “Safety, tolerability, and clinical response after fecal transplantation in children and young adults with ulcerative colitis.” J Ped Gastroenterol Nutr. 2013 Mar 29. [Epub ahead of print]
  2. E.O. Petrof, et al., “Stool substitute transplant therapy for the eradication of Clostridium difficile infection: ‘PePOOPulating’ the gut.” Microbiome. 2013;1:3.
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