Fecal microbial transplantation (FMT) via enema is shown to be effective, tolerable, and feasible for treating children with ulcerative colitis (UC), according to findings from a phase 1 pilot study published online March 29 and in the June issue of the Journal of Pediatric Gastroenterology and Nutrition.

It involves infusion of human stool from a healthy adult donor into the patient’s intestine and has been proposed as an option for recurrent [Clostridium] difficile infection and possibly for ulcerative colitis as per Sachin Kunde, MD, MPH, from Spectrum Health Medical Group, Helen DeVos Children’s Hospital in Grand Rapids, Michigan. The procedure may restore ‘abnormal’ bacteria to ‘normal’ in patients with [UC].

Ten children, aged 7 to 21 years, who had mild to moderate UC, received freshly prepared fecal enemas daily for 5 days.
The investigators collected data on tolerability, adverse events, and disease activity during FMT and weekly for 4 weeks thereafter. At baseline, pediatric UC activity index ranged from 15 to 65. The investigators considered a reduction in PUCAI by more than 15 to be clinical response, and PUCAI lower than 10 to be clinical remission.

There were no serious adverse events. Self-limiting adverse events were mild cramping, fullness, flatulence, bloating, diarrhea, blood in the stool, and moderate fever. Although 1 child could not retain fecal enemas, average tolerated enema volume in the other 9 children was 165 mL/day.

Clinical response within 1 week occurred in 7 (78%) of the 9 children, including 3 (33%) who had clinical remission and 6 (67%) who maintained clinical response at 1 month. Compared with baseline, median PUCAI significantly improved after FMT.
(Medscape)

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