Long-Term Follow-Up Study of Fecal Microbiota Transplantation (FMT) for Ulcerative Colitis (UC)

Abstract

Purpose: The etiology of UC is unknown, but likely multifactorial, with the pathogenic role of intestinal flora being increasingly appreciated. FMT restores the diversity of the fecal microbiome in patients with C. difficile infection (CDI), and has resulted in impressive cure rates. The purpose of this study was to determine if FMT in UC results in similar therapeutic benefit. Methods: A long-term follow-up study was performed on the use of FMT in patients with UC. All patients underwent colonoscopic FMT (CFMT) at Montefiore Medical Center in 2010-2012. Six of 6 eligible patients were contacted and completed a questionnaire soliciting pre- and post-FMT and donor data. Results: 33% of patients were men with a mean age of 44 yrs (range: 26-73 yrs). Follow-up was from 3 to 13 months (mean: 6.2 months). First-degree relatives accounted for 33% of donors; the remaining 67% were spouses or otherwise related. All patients underwent one CFMT. After CFMT, our current UC regimen includes self-administered fecal enemas (SAFE) in a tapered and maintenance schedule; only one of our study patients was unable to successfully infuse and retain the SAFE. Although all 6 of our patients reported improvement after CFMT, the degree of benefit varied. Maximal benefit was seen in the subgroup of patients with concomitant CDI (n=2) and newly diagnosed UC in the setting of antibiotic use (n=1). These three patients reported improvement in stool frequency post-CFMT (pre-CFMT: >8 stools/day; post-CFMT: at baseline); resolution of abdominal pain (pre-CFMT: mild-severe; post CFMT: none); abdominal distention (pre-CFMT: none-moderate; post-CFMT: none); and rectal bleeding after CFMT (pre-CFMT: 10%-50% blood; post-CFMT: none). Cessation of oral prednisone was possible in 2 of these 3 patients, however, 1 patient seems to require low-dose daily prednisone (3 mg) in addition to azathiaprine. CFMT was not as effective in the 3 remaining patients, whose UC onset or worsening was not associated with CDI or antibiotic use. When these 3 patients were successfully performing SAFE, they all noted some improvement in stool frequency (pre-CFMT: 12 stools/day; post-FMT: 5 stools/day) and rectal bleeding (pre-CFMT: >50% blood; post-CFMT: none - <10%) post-CFMT. However, symptoms worsened in 1 patient who became unable to successfully infuse and retain the SAFE and in another patient upon tapering of SAFE. Conclusion: In this small group of patients with UC, FMT treatment seemed to effect the best clinical response in patients whose onset of UC was associated with an alteration in the fecal microbiome from antibiotic use or concomitant CDI.