The treatment uses a colonoscopy to insert a poop sample from a healthy person into the colon of someone with UC. It’s designed to reconstitute the gut with healthy bacteria and induce remission by making the gut less prone to the inflammation that can trigger a UC flare-up. Previous research found that FMT plus antibiotics was an effective treatment protocol for short-term relief (about four weeks). And a new Japanese study, published in January 2020 in Inflammatory Bowel Diseases, shows that this treatment is especially effective if the fecal donor is a sibling. In the study, 79 patients with active UC received three antibiotics: amoxicillin, fosfomycin, and metronidazole. Of those 79 patients, 47 also received a fecal transplant with donor feces from a spouse, parent, or sibling. After four weeks, nearly 66 percent of the patients with UC receiving antibiotics and FMT responded well to the dual treatment, with 40 percent achieving clinical remission. In the antibiotics-only group, roughly 56 percent of patients showed a clinical response to treatment and only 18.7 percent achieved remission. Researchers followed-up two years later and found that 33.3 percent of the antibiotics-plus-FMT group remained in remission compared with 22.2 percent of the group that received only antibiotics. In the study, 10 patients in the antibiotics plus fecal donor group didn’t relapse after 24 months; 7 of those patients were recipients from sibling donors. Overall, sibling donor-recipient pairs had a significantly higher maintenance rate compared with parent-child pairs. In the study, relapse was defined as an increase in a clinical activity index (CAI) score or an intensification of treatment and switching to a new treatment. The study contributes to the growing body of evidence showing that antibiotics plus fecal transplant may be an effective treatment for UC in the short and longer term. “This study shows the importance of matching donors and patients for FMT for long-term maintenance of UC,” says the study’s lead researcher, Koki Okahara, MD, a scientist with the department of gastroenterology at the Juntendo University School of Medicine in Tokyo. “Related healthy individuals are known to have similar gut microbiota. And some studies have reported that acquisition of gut microbiota occurs predominantly over the first few years of life. So, in my opinion, gut microbiota of siblings may reflect microbiota before the development of UC in the patients,” Dr. Okahara says. RELATED: How One Mom Treated Her Child’s Ulcerative Colitis With Fecal Microbiota Transplants
How Safe Is Fecal Microbiota Transplantation?
In June 2019, the U.S. Food and Drug Administration (FDA) issued a statement informing healthcare providers and patients about the potential risk of serious or life-threatening infections with the use of fecal microbiota for transplantation after one person was sickened and another person died as a result of receiving investigational FMT. But the study’s researchers say the treatment is relatively safe. The antibiotics can cause diarrhea, rash, and nausea initially, with symptoms improving over time. FMT can also bring on nausea and diarrhea, but in the study, “those symptoms were brief, and no serious infection or diarrhea was observed,” Okahara says.
Where Might FMT Fit Into Your Treatment Options?
Some doctors believe that undergoing FMT with a sibling donor should be your first option when it comes to UC treatment. “Because antibiotics and fecal microbiota transplantation are safe and low-cost, we believe it’s better to choose it as a first treatment, ahead of other treatments,” says a coauthor of the study, Dai Ishikawa, MD, PhD, the chief of the FMT research group at Juntendo University School of Medicine. But others think it’s too early to consider FMT for UC, especially in lieu of recommended treatments, such as corticosteroids and biologic medication to induce remission. “FMT is generally safe, and this is an exciting study, but we’re still in the early stages and other studies have reported mixed results,” says Alison Schneider, MD, a gastroenterologist at Cleveland Clinic Florida, in Weston. “More research is needed to demonstrate the effectiveness of FMT for UC,” she says. There’s a lot that’s still unknown, such as the number of fecal transplants needed to induce remission, the best way to deliver the fecal matter, such as capsule or enema, and the kind of bowel preparation the recipient should receive, she says. It’s also important to keep in mind that anytime fecal matter is transplanted, there’s a risk the donor stool could contain something unexpected, such as drug-resistant organisms. If, however, FMT for UC proves to be safe and effective, it could save patients with UC money if it helps them avoid biologic medication or being hospitalized, which are the main drivers of healthcare costs for UC patients, Schneider says. In the meantime, if you do opt for FMT, don’t try this at home, as in using donor stool from a sibling or a stool bank, otherwise known as self-FMT. “Patients with UC are desperate for FMT because they want to feel better. But FMT needs to be administered in a clinical trial so patients can be screened and monitored appropriately,” Schneider says.
