GastroEndoNews: Kids With Crohn’s, Colitis Benefit From Fecal Transplant
Study is notable for longer follow-up period: three participants were in clinical remission after six months.
Senior investigator, Dr. Alka Goyal, Children's Mercy, noted a higher than expected response rate among pediatric patients with Crohn's disease at 71%. Of those with ulcerative colitis, 50% experiened a clinical response.
By David Wild
Fecal transplant is an effective way to treat Crohn’s disease or ulcerative colitis in children, researchers have found.
A study from the University of Pittsburgh showed that 71% and 50% of patients with Crohn’s and UC, respectively, experienced a clinical response to fecal microbiota transplantation (FMT) one month after the procedure.
The high response rate among patients with Crohn’s disease is particularly notable, said senior investigator Alka Goyal, MD, who completed this study while at the University of Pittsburgh.
“While some previous data suggested Crohn’s disease may not be very responsive to FMT, our findings, along with other results, suggest that children with Crohn’s disease may actually have better outcomes than those with UC,” said Dr. Goyal, who is now associate professor of pediatrics and director of the inflammatory bowel disease service at Children’s Mercy Kansas City. Dr. Goyal’s group reported the results at the 2017 Digestive Disease Week (abstract Tu1757).
Dr. Goyal and her colleagues presented data from 14 children (mean age, 12 years) with UC or indeterminate colitis and seven children with Crohn’s disease who had taken part in an open-label, single-center prospective trial. The study participants had mild to moderate disease, with poor response to prior medical treatment and no active strictures, abscesses, obstructions of the small bowel or fistulizing disease at the time of transplantation, according to the researchers.
All patients received one dose of fresh stool from a healthy relative by jejunoscopy and colonoscopy.
Dr. Goyal’s team defined clinical response as a decrease of 12.5 points on the Pediatric Crohn’s Disease Activity Index (PCDAI) or a 15-point decrease on the Pediatric Ulcerative Colitis Activity Index (PUCAI).
According to the investigators, half of patients with UC or indeterminate colitis experienced a clinical response to FMT one month after the procedure, and three patients maintained clinical response six months after transplantation.
Among patients with Crohn’s disease, 71% (5/7) had a clinical response at one month and three patients maintained a clinical response at six months. Two patients with Crohn’s were in clinical remission at six months. Clinical remission in this group was defined as a normal fecal calprotectin and lactoferrin along with a score of 0 on the PCDAI.
“I think our study is notable for its long follow-up period, whereas previous studies have included relatively short-term follow-up.”