Purpose: Fecal Microbiota Transplantation (FMT) has traditionally been employed in Clostridium difficile infection (CDI), achieving near 100% cure rates1. However, preliminary reports are emerging of FMT's reversal of idiopathic Ulcerative Colitis (UC)2. To date, analysis of remission rates and treatment response to FMT in UC have not been available. At CDD, FMT has been offered as a treatment option for patients with UC since 1988. We provide an analysis of this cohort of patients aimed at documenting the success rate of this therapy. Methods: A review of all UC patients who underwent FMT at our centre was conducted. UC diagnosis was confirmed clinically, endoscopically, and histologically. Patients with indeterminate colitis or Crohn's Disease were excluded from the analysis. Sixty-two patients (40M; m 42.3 +/- 11.5y: 22F m 48.45 +/- 16.49y) with active UC and follow-up results were included in the analysis. Clinical remission was defined as a 0-1 modified Powell-Tuck index and partial remission as a ≥2 point decrease. Non-response was defined as ≤2 point decrease, unchanged score, increase in score over two consecutive visits, surgical intervention, or FMT-related adverse event requiring treatment cessation. Results: Overall, 91.9% of patients responded to FMT. Of these, 67.7% of patients (42/62) achieved complete clinical remission, and 24.2% of patients (15/62) achieved partial response. The remaining 8% (5/62) were treatment failures. Improvement in CRP and ESR correlated with clinical response observed in FMT patients. Twenty-one patients underwent repeat colonoscopy with a mean time to follow-up of 33 mths (range 1-198 mths). Of these 12/21 (57.1%) were found to have profound mucosal healing with a normal mucosal appearance, return of vascular pattern and no histological inflammation, but in one patient scarring was seen in areas of previously severe inflammation. A further eight patients (8/21, 38.1%) achieved normalisation of mucosa but had some isolated areas of patchy, mild inflammation. One patient (1/21, 4.8%) had remaining active colitis. FMT was well tolerated and produced no significant adverse events. Conclusion: FMT achieves high response rates in UC, and can cure UC in a subset of patients. This should be followed with blinded trials and metagenomic analyses to establish protocols for successful remission in UC. This is the first analysis of UC response rates in relation to FMT.
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Borody et al. (2012) studied this question.