Does fecal transplant help Crohn's disease or colitis?
There has been some research suggesting fecal microbial transplant (FMT) might be a treatment for Crohn's disease and ulcerative colitis. In a first clinical trial published in Gastroenterology and Endocrinology News, scientists report mixed results.
The first clinical trial shows FMT didn't work any better than placebo, despite anecdotal reports of FMT Crohn's disease "cures" that can be found on the internet.
FMT no better than placebo
Perhaps the good news is that the researchers suggest fecal transplant might work to treat IBD if given more than 6-weeks, which is what the clinical trial involved.
Another bit of good news is that fecal microbial transplant might help some people, but who the therapy would help requires more research.
In a subanalysis of the study, five out of 15 patients given FMT for 6 to 12 weeks experienced subjective improvement in addition to clinical remission of IBD.
“These studies all show that FMT may have a therapeutic role in treating IBD, but the precise patients for whom it is best suited and the best approach to administering it need to be further studied,” said Dr. Brandt, who was not involved in the latest research.
Brandt is professor of medicine and surgery at Albert Einstein College of Medicine and emeritus chief of the Division of Gastroenterology at Montefiore Medical Center, in New York City.
Paul Moayyedi, MD, from McMaster University in Hamilton, Ontario, Canada who led the study explained to Medscape Medical News that the study was essentially negative - but there is still hope because much remains to be explored about gut microbes that are thought to trigger the immune dysfunction seen in ulcerative colitis and Crohn's disease.
Moayyedi believes it is food or something in the microbiome of the gut that drives the immune response, something he told Medscape has gotten little attention
"Surely, there is something driving the immune dysregulation. It's likely that the antigen causing ulcerative colitis is food-ingested or in the gut microbiome," Moayyedi said.
The study included 27 people randomized to receive FMT and 26 were selected for placebo. Four patients receiving the treatment and two given placebo achieved clinical remission that according to the researchers was not statistically significant and was based on Mayo scored of 2 or less and Mayo endoscopy score of 0.
There was a thirty-percent improvement in Mayo scores among seven FMT patients and eight placebo recipients.
Everyone in the study had active inflammatory bowel disease and had not taken antibiotics for one month before the trial. Participants had endoscopy Mayo scores of 1 or higher and Mayo scores 4 or above. Approximately forty-five percent in both placebo and FMT treatment group had pancolitis, forty-two percent were receiving steroids, nine percent biological therapy and 19 percent immunosuppressive therapy and all tested negative for Clostridium difficile.
In a separate study, one FMT was administered to seven patients with UC. Biopsies were taken before and one month after the colonoscopic infusion. Just one patient obtained remission after one month that was not maintained.
Everyone in the additional study had improvements in scores on the Ulcerative Colitis Disease Activity Index (UCDAI).
What the studies mean
Because the results were mixed, researchers still don't know if FMT protocol is useful as a treatment for IBD. The suggestion is that the treatment is safe, may not work for everyone and may require maintenance infusions.
The trial results were presented at Digestive Disease Week (DDW) 2014 and published in August in Gastroenterology & Endoscopy News.
Dr. Brandt said the research points to the need to "refine FMT protocols" to find out exactly which patients would benefit. Brandt added that fecal transplant "may" have a therapeutic role in treating IBD but more studies are needed.
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