Faecal Bacterial Transplantation in Ulcerative Colitis

The latest edition of Gastroenterology July 2015 contains 2 reports on the use of faecal transplantation in the treatment of ulcerative colitis. This has been a technique which has been rumbling on for many years now. Reports of dramatic improvements in UC first appeared at the end of the last century and indeed we tried it ourselves at Addenbrookes in an attempt to reduce hydrogen production in patients with colonic cysts, by transplanting faeces from healthy individuals containing bacteria which were capable of converting hydrogen to methane. That particular study was entirely unsuccessful but faecal transplantation has now become an accepted treatment for cases of infection with Clostridium Difficile that have not responded to more straightforward methods.

One study came from Canada and the other from Holland – both were randomised placebo controlled trials of transplantation of healthy faeces in patients with UC. In the Dutch study, 7 out of 23 patients who received healthy faeces went into remission and 5 out of 25 controls. In the Canadian study 9 out of 38 patients receiving healthy faeces went into remission compared to 2 out of 37 controls. The Canadian result is statistically just significant but both trials were disappointing in that overall the results were relatively poor. However, there were no significant ill effects in either study.

Ulcerative colitis patients have an abnormal faecal microflora which attracts an attack from the body’s immune system and the idea of bacterial manipulation to prevent this immune attack is surely the right way forward. However, we need a great deal more information before faecal transplants where one is providing a crude and poorly defined medium, seems unlikely to be the best way forward. Cynics may claim may the benefits in these studies owed little to faecal transplantation. In both studies the bowel was cleared out before the donor faeces was instilled and as proximal constipation is a major factor in the perpetuation of colonic inflammation, the clearout alone may have been responsible for the improvements observed. Much more study of the metabolic effects of the gut bacteria is needed before an ideal bacterial cocktail can be constructed which may provide a long term treatment for UC.

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