FMT shows promise in treating ulcerative colitis

Faecal microbiota transplantation has emerged as an effective treatment for patients with ulcerative colitis, a group of Australian researchers have told an international conference.

Speaking at Digestive Disease Week 2016 in California this week, NSW University researcher and gastroenterologist, Dr Sudarshan Paramsothy revealed a new study had found 11 of the 41 patients (27%) treated with FMT not only had their symptoms cleared, but their colons healed as well.

Healing and improvement in the condition of the digestive tract was evidenced via endoscopic examination. The researchers also noted these results were achieved without the use of steroids.

By comparison, only three of the 40 patients (8%) in the control group reached this goal.

Dr Paramsothy said the study was the first multi-centred trial that used an intense therapy of FMT infusions (40 over eight weeks), and has been able to show definitively that FMT transplantation is an effective treatment for UC.

Previous studies using FMT to treat UC have been limited to small case series and two single-centre trials – with both producing conflicting results, he said.

Speaking to the limbic in the days following his presentation, Dr Paramsothy said that while the results are yet to be formally published in full manuscript form, he was pleased with the reaction.

“The positive reaction to the presentation reflects the interest amongst researchers, physicians and patients alike in the gastrointestinal microbiota and the potential of therapeutic microbial manipulation,” he said.

FMT is now widely accepted as the most effective therapy for recurrent Clostridium difficile infection. And while this latest study demonstrated FMT was a promising therapy for UC, Dr Paramsothy said there were still some questions that needed to be addressed including:

  • microbial characteristics of donors and patients that may influence outcomes, and the possible need to match donors and patients based on their microbial profile
  • long term outcomes including safety

He said FMT accessibility for recurrent Clostridium difficile remained an issue in Australia, with only a “handful of public hospitals” with an established FMT program in place.

“In the US, there is a public stool bank (OpenBiome) which services centres across the entire country, as well as neighbouring countries,” he told the limbic.

“They have facilitated in excess of 2000 FMTs for Clostridium difficile and also collaborate in research activities. The advantages of this approach are uniformity, easier regulation, quality control, centralised data collection and decreased cost due to economies of scale (in terms of donor screening and actual FMT production).

Such an approach would be valuable in Australia and improve accessibility, especially outside the major cities.”

There was still also an element of stigma attached to the use of FMT, but he believes this was shifting as patients and clinicians saw the dramatic efficacy of FMT in Clostridium difficile colitis.

“Our understanding of the gastrointestinal microbiota and the critical role it plays in health and disease is becoming clearer,” he said.

“There have been studies showing that patients are quite receptive to the idea of FMT. While many believed that physicians were more resistant to FMT, a small study we published last year showed surprising enthusiasm as to the potential of FMT amongst gastroenterologists.”

Meanwhile, the researchers are putting the large number of faecal and colonic samples collected during the trial to good use.

“This will enable comprehensive molecular microbiological analyses to try and understand the underlying mechanism of FMT in UC both in terms of microbial compositional and functional changes that may be of importance,” Dr Paramsothy said. “These studies are currently underway.”

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