Submitted, Not Presented: Inflammatory Bowel Disease.

Abstract

Introduction: Steroid dependance develops in 15- 20% of patients of ulcerative colitis. These patients are prone to develop various side effects of long term steroid abuse. Medical treatment options in such cases, biologicals and/or immunosuppressive are expensive and associated with significant toxicity. Recently, there have been reports of FMT being effective in some of these patients. We evaluated the efficacy and safety of fecal microbiota transplantation(FMT) in patients with steroid dependant ulcerative colitis Methods: We report the data of an open label study of FMT in induction and maintainance of remission of patients with steroid dependant ulcerative colitis. Baseline demographic disease characteristics, disease severity and drug history at enrollment were recorded. FMT protocol was 2 weekly for 2 times and then 4 weekly for 5 times (a total of 7 sessions). Clinical and endoscopic response was assessed using mayo score at week 4, end of study period (6 months) and follow up of 6 months.Figure 1Figure 2Results: A total of 17 patients were enrolled. Of these, 10 were males and mean age for the whole group was 35.23 years (23-55). Seven patients (41.1%) had pancolitis and 10 (58.8%) had left sided disease. All patients (n = 17) had moderate to severe disease. Fifteen of 17 (88.23 %) patients achieved clinical remission at week 4. Ten (58.8 %) stayed in remission at the end of 6 months of treatment and 6 months follow up period, allowing stoppage of steroids. Five (29.4 %) patients who initially responded to FMT, eventually had worsening of symptoms and were given adalimumab. Of the remaining 2 patients, 1 (5.8 %) was lost to follow up after a single session of FMT, while the other (5.8 %) developed toxic megacolon after 2 sessions, then post operative sepsis and died. Conclusion: FMT is a promising therapeutic option for patients having steroid dependant ulcerative colitis. Previous exposure to immunosuppressives or biologicals does not hamper response to FMT. However, Randomized, placebo controlled trials from developing countries are needed for more robust data.