By David Wild

Only one of five patients with moderate to severe ulcerative colitis (UC) who were treated with fecal transplantation (FT) experienced clinical and endoscopic improvements following the procedure, according to an abstract presented at the 2012 United European Gastroenterology Week (abstract P374).

Lead investigator Walter Reinisch, MD, associate professor in the Division of Gastroenterology and Hepatology at the Medical University of Vienna, Austria, conducted the procedure in two women and three men with moderate to severe UC who were resistant to previous other treatments. All participants were undergoing immunosuppressant therapy before FT and discontinued treatment before transplantation. All patients received antibiotics and probiotics for five to 10 days before the procedure and underwent a single bowel lavage immediately before transplantation. Healthy adult fecal donors were screened for enteric pathogens and viral diseases.

Dr. Reinisch simultaneously administered a saline-diluted fecal solution via a nasojejunal tube (median 23.8 g) and an enema (median 20 g). All of the patients experienced fever, increased C-reactive protein (CRP) levels and exacerbated UC symptoms during the first procedure, and one recipient also experienced emesis. The procedure was repeated over three consecutive days in all but one patient, whose fever and increases in CRP levels were more severe and required discontinuation of treatment until five weeks after initial administration.

During the follow-up period, adverse events included upper respiratory tract viral infection, pruritus, erythema, paresthesia of the hip, fainting and tongue blistering.

There was no evidence of bacterial pathogens in blood cultures, Dr. Reinisch reported, and hydrogen-glucose breath tests showed that none of the patients had small bowel bacterial overgrowth.

Twelve weeks after FT, clinical disease activity had worsened in two patients. The Mayo Scoring System for Assessment of UC Activity showed a decrease in median scores from 11 at baseline to 9 among the three patients who did not experience clinical disease flares and who completed the protocol. One patient experienced a Mayo endoscopic subscore change from 3 to 2.

“Although plenty of donor-derived bacteria were established in all of the patients, successful colonization by beneficial bacteria, such as Faecalibacterium prausnitzii, was achieved only in the one patient who had a good clinical response,” Dr. Reinisch noted. His group is investigating whether patients with milder UC experience a more favorable response to FT, citing positive findings from a case series that included six patients with a less aggressive form of UC (J Clin Gastroenterol 2003;37:42-47).

Lawrence Brandt, MD, professor of medicine and surgery at Albert Einstein College of Medicine, and emeritus chief of the Division of Gastroenterology at Montefiore Medical Center, both in New York City, did not see similar outcomes in 22 patients with UC that he treated with FT.

“I haven’t analyzed data from my patients but my impression is that some respond very well to FT,” he said. “Now the challenge is to discover who and why. There is so much variability in how FT is done, and so much detail was left out of this abstract, that it is difficult to say why the results were poor.”