P427 Fecal microbiota transplantation in refractory pediatric UC - preliminary data.
K. Karolewska-Bochenek*1, I. Lazowska-Przeorek1, P. Grzesiowski2, A. Banaszkiewicz1, P. Albrecht1, A. Gawronska1, A. Radzikowski1, M. Kotowska1
1Medical University of Warsaw, Department of Pediatric Gastroenterology & Nutrition, Warsaw, Poland, 2Fundacji Instytut Profilaktyki Zakazen, Fundacji Instytut Profilaktyki Zakazen, warsaw, Poland
Ulcerative colitis is characterized by a dysregulated immune reaction and associated with fecal dysbiosis. Fecal Microbial Transplant (FMT), by changing the gastrointestinal microbiome of patients with UC, may be a potential therapeutic option. For Clostridium difficile infection FMT is an effective alternative treatment. This therapeutic option has been rarely explored in children with UC, however preliminary data have shown some effectivness of FMT in adults and children with UC. The aim was to assess the efficacy of FMT in children with refractory UC.
Four children, ages ranged from 10-17 years (3 girls) with moderate to severe UC defined by PUCAI, refractory to standard therapy (steroids, immunomodulators, cyclosporin, tacrolimus, anti-TNF) were treated with FMT. They received50 ml FMT via gastroscopy on 5 consecuitive days in first week and every other day in the second week (8 infusions in 14 days). Donors, not related to patients, were healthy and screened for HIV, HAV, HBV, HCV, HAV, EBV, Treponema pallidum, Clostridium difficile, ova & parasites. Patients were evaluated using PUCAI, CRP and fecal calprotectin on the day before the first infusion (0 week), and during follow up period at 2, 4 weeks post transplant. Study subjects were maintained on their pre-transplant medications and PPI was added during FMT treatment.
Four patients with longstanding refractory UC received 8 infusions of FMT in 14 days. All patients had good tolerance and clinical response to FMT. We did not register any serious adverse effects. In 3 patients transient vomitting were observed in the first 2 days. All patients clinically improved (PUCAI). Inflammatory markers decreased in all patients (CRP and fecal calprotectin) at 2 week, but they rapidly increased in next 2 weeks without FMT administration (table 1). None of the patients achieved complete remission.
“clinical and laboratory data of patients”
This study shows that in children with UC refractory to standard therapy, multiple dose of FMT via gastroscopy have clinical benefit but not remission in short-term observation. FMT was well tolerated and safe in active and longstanding pediatric UC. Long-term follow-up studies are required to fully assess effectiveness and safety of FMT as novel therapeutic option in pediatric UC.