Pediatr Gastroenterol Hepatol Nutr.  2018 Oct;21(4):355-360. 10.5223/pghn.2018.21.4.355.

Fecal Microbiota Transplantation to Patients with Refractory Very Early Onset Ulcerative Colitis

Affiliations
  • 1Department of Pediatrics, Okinawa Chubu Hospital, Okinawa, Japan. lucky.toshist@gmail.com
  • 2Division of Clinical Epidemiology, Jikei University School of Medicine, Tokyo, Japan.
  • 3Department of Emergency Medicine, Mary Bridge Children's Hospital, Tacoma, WA, United States.

Abstract

Recently, fecal microbiota transplantation (FMT) has been attracting attention as a possible medical treatment of ulcerative colitis (UC). A randomized controlled trial of FMT for children with UC is currently underway. Therapeutic effects of FMT for adults with UC remain controversial. We report two cases of early-onset UC in children. A patient was diagnosed with UC at age 1-year 9-month and underwent FMT at age 2-year 3-month. He attained clinical remission for three weeks after FMT, but then relapsed at four weeks, ultimately undergoing a total colectomy. Another child was diagnosed with UC at 2-year 10-month and she underwent FMT at age 5 years. She has remained in clinical remission following FMT for 24 months and her UC has been maintained without complications with tacrolimus and azathioprine. We report that FMT for early-onset UC appears to be safe and potentially effective.

Keyword

Fecal microbiota transplantation; Ulcerative colitis; Inflammatory bowel colitis; Colectomy; Gastrointestinal microbiome

MeSH Terms

Adult
Azathioprine
Child
Colectomy
Colitis, Ulcerative*
Fecal Microbiota Transplantation*
Gastrointestinal Microbiome
Humans
Tacrolimus
Therapeutic Uses
Ulcer*
Azathioprine
Tacrolimus
Therapeutic Uses

Figure

  • Fig. 1 The endoscopic findings of case 1. Transverse colon (A) before fecal microbiota transplantation (FMT), and (B) at one week after starting FMT. (A) demonstrated severe diffuse and continuous mucosal inflammation with erythema and bleeding, whereas (B) demonstrated improved erythema and vascular pattern.

  • Fig. 2 Fecal microbiota composition of the recipient and donor measured by T-RFLP (terminal restriction fragments length polymorphism). Before fecal microbiota transplantation (FMT), Bacteroides fragilis comprised more than two-thirds of the patient's microbiota. The graphs demonstrate that the patient's microbiota composition was quite different from the donor. However, fecal analysis three months after FMT revealed intestinal bacterial flora that was similar to that present in the stool of the donor, that led to clinical remission of ulcerative colitis activity for the subsequent two years.


Reference

1. Asakura K, Nishiwaki Y, Inoue N, Hibi T, Watanabe M, Takebayashi T. Prevalence of ulcerative colitis and Crohn's disease in Japan. J Gastroenterol. 2009; 44:659–665.
Article
2. Morita N, Toki S, Hirohashi T, Minoda T, Ogawa K, Kono S, et al. Incidence and prevalence of inflammatory bowel disease in Japan: nationwide epidemiological survey during the year 1991. J Gastroenterol. 1995; 30:Suppl 8. 1–4.
3. Japanese Ministry of Health, Labour and Welfare. Handbook of health and welfare statistics 2016 contents. Table 2-22 number of persons with specific (intractable) disease healthcare certificate by disease and sex [Internet]. Tokyo: Japanese Ministry of Health, Labour and Welfare;2018. cited 2018 Jan 15. Available from: http://www.mhlw.go.jp/english/database/db-hh/2-1.html.
4. Ishige T, Tomomasa T, Takebayashi T, Asakura K, Watanabe M, Suzuki T, et al. Inflammatory bowel disease in children: epidemiological analysis of the nationwide IBD registry in Japan. J Gastroenterol. 2010; 45:911–917.
Article
5. Uhlig HH, Schwerd T, Koletzko S, Shah N, Kammermeier J, Elkadri A, et al. The diagnostic approach to monogenic very early onset inflammatory bowel disease. Gastroenterology. 2014; 147:990–1007.
Article
6. Kelsen J, Sullivan K. Immune dysregulation associated with very early-onset inflammatory bowel disease. In : Mamula P, Grossman AB, Baldassano RN, Kelsen JR, Markowitz JE, editors. Pediatric inflammatory bowel disease. 3rd ed. Switzerland: Springer;2017. p. 55–67.
7. Rinawi F, Assa A, Eliakim R, Mozer Glassberg Y, Nachmias Friedler V, Niv Y, et al. Predictors of pouchitis after ileal pouch-anal anastomosis in pediatric-onset ulcerative colitis. Eur J Gastroenterol Hepatol. 2017; 29:1079–1085.
Article
8. Dharmaraj R, Dasgupta M, Simpson P, Noe J. Predictors of pouchitis after Ileal pouch-anal anastomosis in children. J Pediatr Gastroenterol Nutr. 2016; 63:e58–e62.
Article
9. Paramsothy S, Kamm MA, Kaakoush NO, Walsh AJ, van den Bogaerde J, Samuel D, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet. 2017; 389:1218–1228.
Article
10. Pai N, Popov J. Protocol for a randomised, placebo-controlled pilot study for assessing feasibility and efficacy of faecal microbiota transplantation in a paediatric ulcerative colitis population: PediFETCh trial. BMJ Open. 2017; 7:e016698.
Article
11. Hourigan SK, Oliva-Hemker M. Fecal microbiota transplantation in children: a brief review. Pediatr Res. 2016; 80:2–6.
Article
12. Shimizu H, Arai K, Abe J, Nakabayashi K, Yoshioka T, Hosoi K, et al. Repeated fecal microbiota transplantation in a child with ulcerative colitis. Pediatr Int. 2016; 58:781–785.
Article
13. Kumagai H, Yokoyama K, Imagawa T, Inoue S, Tulyeu J, Tanaka M, et al. Failure of fecal microbiota transplantation in a three-year-old child with severe refractory ulcerative colitis. Pediatr Gastroenterol Hepatol Nutr. 2016; 19:214–220.
Article
14. Wang S, Xu M, Wang W, Cao X, Piao M, Khan S, et al. Systematic review: adverse events of fecal microbiota transplantation. PLoS One. 2016; 11:e0161174.
Article
15. Vandenplas Y, Veereman G, van der Werff Ten Bosch J, Goossens A, Pierard D, Samsom JN, et al. Fecal microbial transplantation in early-onset colitis: caution advised. J Pediatr Gastroenterol Nutr. 2015; 61:e12–e14.
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