Fecal microbiota transplants for pouchitis not yet effective

Fecal microbiota transplants (FMTs) are generally accepted as an often-effective treatment for Clostridium difficile infection. To date, this is the only accepted use of FMTs however many scientists and clinicians have proposed other uses of FMTs to treat chronic conditions. One such condition is called pouchitis.

Patients with ulcerative colitis or other diseases often need a total proctocolectomy, the surgical removal of their large intestine and rectum, and have their small intestine connected to the anus to create a pouch to eliminate stools. When this “pouch” becomes inflamed or swells after being irritated, pouchitis results. Approximately half of all patients who need this procedure done get pouchitis in their lifetime and many get it every year.

Researchers in the UK hypothesized that FMTs could be used to treat pouchitis because it is thought that these patients have a dysbiosis. They conducted a trial of 8 patients with chronic pouchitis and published the results in Scientific Reports. After administering the FMT through a nasogastric tube, they analyzed clinical outcomes as well as microbiota composition as well as the immune response. Most importantly, they did not see any significant improved clinical outcomes despite some changes to the microbiome composition and in some individuals, the suggestion of a healthier microbiome as a result in changes in proportion of bacterial species abundance.

This negative result (which is always good to see published) leaves the door open for many further questions in regards to the use of FMTs in IBD including what is the proper route of administration, how often, and what interventions should be conducted prior to treatment. These and many more questions remain as clinicians aim to use FMTs in the treatment of IBD. 

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