Fecal Microbial Transplant- A New Hope of Treatment for Ulcerative Colitis

Purpose: Ulcerative colitis (UC) is a chronic idiopathic inflammatory bowel disease of intestines. The high cost of second line drugs along with the need for lifelong therapy are the most distressing factors demanding innovative therapy for treating this disease. Fecal microbial transplantation (FMT) can be used as an adjunct for treating UC. We performed FMT in a six year old male child who was being treated for ulcerative colitis with conventional therapy for the last two years with variable response to therapy. This therapy also has good potential as salvage therapy for refractory multidrug resistant Gram negative organisms and Clostridium difficile infection. Methods: After taking appropriate informed consent, a healthy adult donor from the family was thoroughly screened for various infections (as per protocol). Donor fecal preparation was done taking strict aseptic precautions and FMT was given as retention enema for 1 h (60 ml enema every 15 min) daily for 5 days. Patient was monitored for adverse event (as per protocol). Results: The patient tolerated the enema well. The Paediatric Ulcerative Colitis Activity Index (PUCAI) reduced from 35 to 15 after completion of five days of therapy. There has been no relapse since FMT and the child continues to be asymptomatic with a stable low PUCAI score 6 months post therapy. Conclusion: Our study is a step and encouragement towards the usage of FMT for pediatric patients with ulcerative colitis showing variable response to conventional treatment. However, more future studies are required to authenticate this treatment modality.