Can FMT be a Successful Pediatric IBD Treatment?
MARCH 06, 2017
While adults with inflammatory bowel disease (IBD) have been treated with fecal microbial transplant (FMT), the jury is still out on whether experts can perform the procedure safely in children.
Researchers from Ontario, Canada examined the existing adult and pediatric literature regarding FMT in IBD treatment to provide a comprehensive overview of FMT and its role in pediatric IBD. The researchers added that because FMT is often a successful treatment for recurrent Clostridium difficile (C. difficile) infection, the process has lately been applied to other diseases.
The study authors reported that only 45 pediatric patients have been treated for recurrent C. difficile infection and only 27 patients with IBD. The investigators also explored the features of the microbiome that could be linked to host response in FMT and potential challenges and opportunities for FMT in pediatric IBD.
The pediatric microbiome and pediatric IBD, are unique, especially because IBD could conflict and overlap with growth periods, bone accretion, and psychological development.
In four published case studies for the treatment of pediatric ulcerative colitis (UC) and Crohn’s disease (CD) using FMT, all three main routes of administration were used: serial enemas, serial enemas with supplementary colonoscopic administration, and nasogastric tube.
The first study showed that 6 of 9 patients maintained clinical response after a one-month follow-up period. In the second publication, comprised of 2 parts, 7 of 9 patients reached remission after 2 weeks, while 5 of those 9 patients maintained remission at week 6 and week 12. The ulcerative colitis patients involved in that study did not produce a clinical response. In the third study, with 3 patients, all reached remission by week 2. Those patients maintained remission by week 4.
“These studies suggest that serial treatment may be required to achieve an appreciable response in IBD patients, in contrast to single, or short-course FMT administrations in the treatment of recurrent C. difficile infection,” the study authors wrote. “This may reflect the chronic nature of IBD, vs. the acute changes that characterize secondary, infectious illnesses like C. difficile colitis.”