Can a Fecal Transplant Help Ease Painful Ulcerative Colitis?

There is a long-time myth that Blacks can’t get inflammatory bowel diseases (IBD) such as Crohn’s disease and ulcerative colitis. However, that myth is untrue. Although Blacks may be at a lower risk for developing an IBD than other races, they can still get them. Black people may also receive different surgical and medical treatment than whites. This can be difficult when dealing with a painful disease such as ulcerative colitis, but research suggests there is a method of treatment that can help ease the pain.

Ulcerative colitis is a chronic inflammatory bowel disease triggering pain and bloody stools, and it can raise the odds for colon cancer.

Fecal transplants — basically, delivering a healthy person’s stool into the colitis patient’s digestive tract — may be an effective treatment, according to research.

The Australian team behind the small study says the strategy may work by introducing millions of healthy bacteria into the dysfunctional tract.

“Bacteria comprise more than half of the fecal mass, [but] not all poop is created alike,” Dr. Arun Swaminath, a U.S. gastroenterologist says.

In fecal transplant, patients receive stool laden with bacteria from a healthy donor’s microbiome — those internal communities of “good” bacteria, Swaminath says. And that might help restore balance to the digestive tract of people with colitis.

In recent years, “new technology has now allowed us to get a deeper understanding of the microbiome,” Swaminath adds. That’s led to the whole replacement of the colonic microbiome with donor fecal transplant.

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The new Australian research involved 73 adults with mild to moderately active ulcerative colitis. The patients received a few treatments of low-intensity fecal microbiota transplantation delivered via colonoscopy.

Patients were divided into two groups: Some received pooled donor fecal matter processed anaerobically (in an oxygen-free environment), while others received their own fecal matter (essentially, a placebo, used for comparison purposes).

The result:

The rate of ulcerative colitis remission was

32 percent for the patients who received the pooled donor stool, compared with just 9 percent in the placebo group.

The rate of remission in the patients who received the donor fecal matter was similar to that achieved with the best current treatments, noted a team led by Dr. Sam Costello, a gastroenterologist at The Queen Elizabeth Hospital, in Adelaide.

Costello notes that many current colitis treatments suppress the immune system, and that can lead to potential side effects, such as infection or even cancer.

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“The most important difference in this trial compared to previous studies is the use of anaerobic (oxygen-free) stool processing,” Costello, who is also a lecturer at the University of Adelaide’s Medical School says.

“Many gut bacteria die with exposure to oxygen and we know that with anaerobic stool processing a large number of donor bacteria survive so that they can be administered to the patient,” Costello explains. “We believe that this may be the reason that we had a good therapeutic effect with only a small number of treatments.”

Dr. David Bernstein, a gastroenterologist and director of the department of hepatology at Northwell Health in Manhasset, N.Y. says the new study is “promising and the results are impressive.” But he stresses that larger studies are needed “to validate these findings.”