Failure of Fecal Microbiota Transplantation in a Three-Year-Old Child with Severe Refractory Ulcerative Colitis

Abstract

Fecal microbiota transplantation (FMT) is a treatment designed to correct gut dysbiosis by administration of feces from a healthy volunteer. It is still unclear whether FMT for children with ulcerative colitis (UC) is effective or hazardous. Here we describe a young patient to have received FMT for UC. A three-year-old girl was admitted to our hospital with severe active UC, and treated with aminosalicylates and various immunosuppressive drugs. As remission was not achieved, we decided to try FMT before colectomy. We administered donor fecal material a total of six times by retention enema (×2) and via a nasoduodenal tube (×4) within 10 days. The patient developed abdominal pain and pyrexia after each FMT session. Analyses revealed the transferred donor fecal microbiota had not been retained by the patient, who ultimately underwent colectomy. The severity of the UC and/or timing of FMT may have partly accounted for the poor outcome.

Inflammatory bowel diseases

“…[22] Also, an innovative trend in the management of patients with IBD is represented by fecal microbiota transplantation, designed to correct dysbiosis in this group of patients. Nevertheless, Kumagai et al [23] described a case of a 3-year-old child with severe refractory UC in which fecal microbiota transplantation has failed in improving the outcome. A current innovative approach of pediatric patients diagnosed with IBD is related to the self-management of their condition.…”

Fecal Microbiota Transplantation to Patients with Refractory Very Early Onset Ulcerative Colitis

“…Among our two patients, the patient that revealed long-term remission underwent FMT via ED tube into the small intestine and the patient that revealed short-term remission received FMT via the colon using CS. Looking at other children in Japan that had previously undergone FMT, a 3-year-old girl that received FMT via extended enema (twice) and via the small intestine (four times) did not go into remission and required total colectomy [ 13 ]. In an 11-year-old female that received FMT via the colon, remission was successfully achieved and continues to be maintained [ 12 ].…”

“…The third observation of our study was that FMT was performed safely in both of our cases of VEO-UC and did not cause severe complications. No major complications have been observed in past reports of FMT in Japan [ 12 , 13 ]; however, reports from other countries have noted cytomegalovirus enteritis and Clostridium difficile infection associated with collected donor stool [ 14 ], and systemic complications such as bacteremia have been reported in cases of FMT in children [ 15 ]. It is important to monitor carefully after implementing FMT.…”

Fecal Microbiota Transplantation as New Therapeutic Avenue for Human Diseases

“…So far, the described clinical trials were performed in adults with ulcerative colitis, but recently interest in FMT strategies come into the spotlight also for pediatric patients . Following a few trials with a low number of pediatric patients yielding conflicting results [ 83 , 84 , 85 , 86 , 87 ], Pai and co-workers (2021) performed the first randomized clinical trial in pediatric patients (aged 4 to 17 years) with active ulcerative colitis. Ninety-two percent of the patients in the FMT arm achieved improvement in pediatric ulcerative colitis activity index (compared to the 50% of the placebo arm) at week 6, and 75% still showed clinical response one year after the transplant.…”