Inflammatory Bowel Disease

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August 17, 2015

Fecal Transplants for Ulcerative Colitis?

By Kanaaz Pereira

There is currently great interest in treating ulcerative colitis with fecal microbiota transplantation (FMT), which involves transplanting gut fecal bacteria from healthy people into patients with ulcerative colitis. Edward Loftus Jr., M.D., a gastroenterologist at Mayo Clinic, talks about two newly published studies in Gastroenterology; both studies examined the efficacy of fecal microbiota transplantation in ulcerative colitis, but arrived at different conclusions.

In the first trial, adult participants received fecal transplants from healthy anonymous donors via retention enema. Results from this trial showed that fecal microbiota transplantation safely induced remission in patients with active ulcerative colitis.

In the second study, patients with moderately active ulcerative colitis were also treated with donor stool; this time it was delivered via nasoduodenal tube, where a tube is inserted down the nose, through the oesophagus and stomach, and into the duodenum. However, the outcome of this study showed no significant improvement in the disease.

Researchers explored the reasons why one trial of FMT for ulcerative colitis was positive, while another was negative. They questioned the different modes of delivery of fecal microbiota, raising the possibility that administering it via the upper GI route might render the active bacteria ineffective by the time it reaches the diseased colon. The difference in frequency of infusions between the two trials could also have been a significant factor.

The jury is still out on whether FMT can effectively treat ulcerative colitis, and Dr. Loftus strongly cautions against a do-it-yourself or at-home treatment. Rather, he encourages patients to be part of a clinical trial, and there is hope that as researchers are able to better understand the active component of FMT, it will enable future therapies.

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Dr. Loftus is a gastroenterologist at Mayo Clinic.

Tags: Edward Loftus, fecal transplant, Gastroenterology, IBD, News Alerts, Study Findings, ulcerative colitis

Excellent video.
Please note: Because the average American has lost 40% of the diversity of their microbiome, this has to be remembered when we design clinical trials. It’s going to skew results if we don’t try our best to transplant the most diverse microbiome possible, a microbiome that hasn’t been already decimated by medications or antibioitcs. Diversity has been closely associated with good health. Glen Taylor is using samples from several different donors, for successive infusions, I would expect in the aim of delivering a more diverse microbiome. But, it seems obvious we need to do better than this. Perhaps foreign students that are at our universities, have better microbiomes with no exposure to antibiotics ? Amish ? Navajo Indians ?

Plus, because many of the microbes in the large intestine are anaerobic, the handling of the donor sample is also critical to the outcome. Kill many of the bacteria by a spinning metal blade, and you also incorporate air which kills even more bacteria. The point is: it is critical to maintain the health of the entire microbiome that is trying to be transplanted. Dr. Borody uses a ‘stomachizer’ to handle the sample, thus eliminating exposure to air, which appears to be on the correct path. He also uses a special antibiotic to knock down the bad bacteria before the procedure, and does an exceptional clean-out too.

At this point for IBD the correct approach may be to start off using 12 different infusions. If that works, then the number can be reduced, with the aim of finding out how many infusions are needed. It’s not wise to assume that one or two transplants are all that is needed to establish this new community of helpful bacteria, after all, the microbiome takes 3 years to be established in an infant, so why do we assume that one or two infusions will establish it ? Removing possible inflammation producing foods from the diet such as gluten and red meat, may also play a role in the treatment of IBD.

Autism has been reversed. MS has been reversed. Chronic Fatigue, Rheumatoid Arthritis and Depression reversed. When will the clinical trials be started here in the US ?
How about Fibromylasia, Lupus, Hay Fever-(nasal microbiome transplant), and Cancer (an FMT after the chemotherapy) ? How about breast milk to reverse lactose intolerance ?(research also shows that the bacteria in the vagina, before birth, helps the infant to digest breast milk) and also breast milk is doing much to establish the microbiome in the infant too.

If you have studied the latest microbiome research, then you already know that it plays a very huge role in our health. Future clinical trials, for all medications will take baseline tests for the microbiome, as well as blood, and other tests. We simply cannot continue to ignore the possible damage we are doing to the microbiome, by the medications we prescribe.

For Heaven’s sake, please get the word out to all MDs that have pregnant patients and educate them as to what antibiotics are doing to the developing microbiome in the first 3 years of life. Pediatricians too. We have to stem the tide against Autism. It’s right here.

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