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.