Fecal Transplant Might Help Treat Ulcerative Colitis

Both our Chief Executive Officer, Gail Attara, and our Development Director, Paul Evered, attended the European Crohn’s and Colitis Organization’s (ECCO) 11th Congress during March 16-19, 2016 in Amsterdam. ECCO accepted a poster co-authored by Gail and five gastroenterologists on subsequent entry biologics, now called biosimilars. The conference hosted 6,265 delegates from 91 countries, all focussing on inflammatory bowel diseases.

While there, other researchers presented their findings on a treatment that might help individuals with resistant ulcerative colitis.1 With the discovery that fecal transplant helps to eradicate the dangerous clostridium difficile infection in patients who don’t respond to other treatments, researchers and physicians are becoming aware of the potential for this treatment to help other diseases and disorders.

Ulcerative colitis is a chronic inflammatory bowel disease (IBD) consisting of fine ulcerations in the inner mucosal lining of the large intestine. Inflammation starts at the lower end of the colon, just above the anus, and extends upward in a continuous manner, to variable distances. Symptoms can include diarrhea, rectal bleeding, abdominal pain, anemia, constipation, fever, joint or eye inflammation, mouth ulcers, and inflamed nodules on the shins. It is a chronic, systemic inflammatory disease manifesting in the colon, which involves lifelong management.

There are a plethora of bacteria and other microbiota living in each individual’s digestive tract, and the types of bacteria can influence health in ways we are only beginning to understand. While no one knows exactly what causes ulcerative colitis, the microbiota in the colon might play a role in some aspects of the disease.

To perform a fecal transplant, physicians take stool from healthy individuals and liquefy it so they can insert it directly (usually via enema or colonoscopy) into the large intestines of patients who are suffering from ailments that it might help. This allows the full balance of microbiota to re-populate the sick individual’s intestine, rather than trying to identify and isolate individual helpful bacteria, as is the case with probiotic supplements taken orally.

In the study, researchers separated 81 individuals with mild to moderate ulcerative colitis into two groups. They gave the 41 test subjects fecal transplant enemas five times per week for eight weeks, and the 40 individuals in the control group a placebo at the same interval. All patients stopped taking steroid medications during the study. The fecal transplants consisted of 150mL of previously frozen stool from three to seven unrelated donors combined together, in order to reduce the chance of a bad batch.

After the eight weeks were up, 44% of those receiving fecal transplant went into remission, compared with 20% of those who were taking the placebo. This offers a novel treatment option for those who have ulcerative colitis and are not responding well to typical medications. However, there are still some problems. We need more research to ensure that fecal transplant is effective, and there are some safety concerns. Since fecal transplant relies on matter from other humans, instead of lab-made medications, it is important to develop adequate ways to test the stool before using it to treat someone with ulcerative colitis.

First published in the Inside Tract® newsletter issue 199 – 2016
Image Credit: © bigstockphoto.com/Paha_L
1. Paramsothy S et al. OP017 Multi-donor intense faecal microbiota transplantation is an effective treatment for resistant ulcerative colitis: a randomised placebo-controlled trial. https://www.ecco-ibd.eu/index.php/publications/congress-abstract-s/abstracts-2016/item/op017-multi-donor-intense-faecal-microbiota-transplantation-is-an-effective-treatment-for-resistant-ulcerative-colitis-a-randomised-placebo-controlledx00a0trial.html