Fecal Transplantation: Any Real Hope for Inflammatory Bowel Disease?

Paul Moayyedi

Disclosures

Curr Opin Gastroenterol. 2016;32(4):282-286. 

In This Article

Fecal Microbial Transplantation in the Treatment of Crohn's Disease

The treatment of Crohn's disease with FMT also dates back to case reports from 1989,[21] and again therapy was successful but single case reports are open to publication bias as usually only successful responses are reported. A systematic review[17] of case series data identified four studies evaluating 38 patients with active Crohn's disease and reported a pooled response rate of 60.5% (95% CI = 28–86%). FMT appears more effective in Crohn's disease than ulcerative colitis but it is important to emphasize that these studies all used clinical response as the outcome, whereas ulcerative colitis studies used a more stringent assessment of mucosal healing. Furthermore, there are no completed RCTs in active Crohn's disease comparing FMT with placebo. The other challenge with treating Crohn's disease is that the terminal ileum is the most frequent region to exhibit inflammation. Retention enemas are therefore unlikely to be effective and colonoscopy delivery is not feasible if multiple FMT infusions are needed. Gastroduodenal delivery is possible but this is not well tolerated by patients in clinical practice. This route of administration is also associated with acute onset of fever in some patients associated with a dramatic rise in C-reactive protein. This has resolved spontaneously in all patients but can be alarming and presumably relates to the delivery of fecal type microbiota to the upper jejunum. FMT given by oral capsule[22] has been developed and may be a less invasive approach to delivering microbiota to the small intestine. If these pills can be reformulated to release bacteria in the distal small bowel, this may also minimize the transient fevers seen in some patients.

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