I distinctly remember one of my high school teachers saying that if you asked someone if they were willing to have a serious operation like a brain lobe removal, that most would be unwilling unless there was no other choice. However, if you told them that you were going to do it with a laser, people would want to get it done right away. Such was the mesmerizing appeal of the word “laser.”
Fecal microbiota transfer (FMT) certainly does not sound as enticing as a laser treatment. Nevertheless, the authors of a recent report state that “we received interest from patients all over the world to participate.” That being said, this recent report reintroduces the concept of FMT for ulcerative colitis (UC) (JPGN 2013; 56: 597-601).
In the introduction, the authors note that probiotics, in particular VSL#3, have shown usefulness in the treatment of UC and have noted previous sporadic reports of FMT for inflammatory bowel disease. This led to their pilot study of 10 subjects (7 to 21 years); this was a single-center, uncontrolled study. Due to financial constraints, there was no correlation with fecal microbial profiling, histologic/colonoscopic activity, or stool inflammatory markers.
The authors extensively describe their protocol of FMT (240 mL [in four aliquots] daily for five days) including donor exclusion criteria and donor screening. Participants did not receive any bowel preparation prior to FMT. The majority of participants had pancolitis; only one patient had disease limited to proctitis. One of the ten patients could not retain FMT enemas.
- Short-term improvement was noted with 7 of 9 (78%) achieving a clinical response within one week and 3 of 9 (33%) achieving a clinical remission.
- The authors note that 6 of 9 (67%) maintained a clinical response at 1 month. Although if one examines the study’s figure 2, this graphically demonstrates a fairly meager response in about half of these patients based on their PUCAI score.
- The authors do not overstate their interpretation of their results. “This unique biologic is potentially efficacious.”
- Adverse effects appeared to be mild and self-limiting.
Ultimately if FMT proves efficacious for inflammatory bowel disease, feces with the right microbial mix would be quite valuable. For now, this study indicates that further research is needed in this area.
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