Oral vancomycin induces clinical and mucosal remission of colitis in children with primary sclerosing cholangitis–ulcerative colitis

Tan, Li-Zsa; Reilly, Claire; Steward-Harrison, Lana; Balouch, Fariha; Muir, Richard; Lewindon, Peter

doi:10.1136/gutjnl-2018-316599

Cited by 36 publications

(19 citation statements)

References 3 publications

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“… 9 The clinically “silent” colitis can be rather refractory to current conventional treatments. 1 This may be one reason for the significantly increased colorectal cancer rate in PSC-UC over non–PSC-UC. 10 Because of these clinical characteristics, novel modes of colitis control, such as vancomycin therapy, are important to investigate.…”

Section: Discussionmentioning

confidence: 99%

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Microbiome Responses to Vancomycin Treatment in a Child With Primary Sclerosing Cholangitis and Ulcerative Colitis

et al. 2021

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The therapeutic effects of off-label oral vancomycin in pediatric and adult primary sclerosing cholangitis (PSC)-inflammatory bowel disease, more commonly PSC-ulcerative colitis (UC), indicate the translational relevance of disease-associated microbiome findings. This is the first report on longitudinal salivary and fecal microbiome changes in a pediatric PSC-UC patient over the first 90 days of vancomycin therapy. Increase in bacterial diversity and abundance changes in Fusobacterium , Haemophilus , and Neisseria were observed. Our findings highlight the importance of longitudinal microbiome sampling in PSC-UC and serve as a nidus for larger-scale observations toward advancing microbial therapeutics for PSC.

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Section: Discussionmentioning

confidence: 99%

“…Tan et al 1 reported that oral vancomycin induces clinical and mucosal remission of colitis in children with primary sclerosing cholangitis-ulcerative colitis (PSC-UC). Distinct microbiome profiles in adult PSC-UC patients have been described.…”

Section: Introductionmentioning

confidence: 99%

Microbiome Responses to Vancomycin Treatment in a Child With Primary Sclerosing Cholangitis and Ulcerative Colitis

et al. 2021

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“…Dao et al described improvements in both ulcerative colitis and PSC in eight patients, five of whom had undergone liver transplant, when treated with oral vancomycin 125 mg four times daily for 6-8 weeks, after which the dose was tapered but not discontinued; all patients maintained endoscopic response/remission [12]. Tan et al described the impact of oral vancomycin on seventeen children with ulcerative colitis and PSC, in which they stated: "There was a striking response of colitis with near universal colonic healing" [13]. Additional case reports have cited the efficacy of vancomycin in the treatment of PSC [14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Is Bartonella a Cause of Primary Sclerosing Cholangitis? A Case Study

Kinderlehrer¹

2020

Gastrointestinal Disorders

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The etiology of primary sclerosing cholangitis (PSC) is unknown. I present a case which may be indicative of a causal link between Bartonella infection and PSC. The patient presented with complaints of abdominal pain and bloody diarrhea. A colonoscopy demonstrated chronic inflammation and changes consistent with ulcerative colitis. Routine laboratory studies revealed elevated liver function tests (LFTs); ultrasound and magnetic resonance imaging (MRI) confirmed the diagnosis of PSC. Bartonella serology was positive. It is established that Bartonella infection is associated with both gastrointestinal inflammation and autoimmunity; indeed, there is an animal model for Bartonella-induced PSC. Bartonella is susceptible to treatment with vancomycin and there are case reports and small series that demonstrate that PSC responds to treatment with oral vancomycin. Because of this, it is postulated that at least some cases of PSC may be associated with Bartonella infection. The patient in this report was treated with oral vancomycin and, since then, has been in remission for both colitis and PSC. Since vancomycin is not systemically absorbed, the premise is that he suffered from Bartonella colitis and an autoimmune reaction to Bartonella causing PSC. This premise warrants further study.

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“…In both studies a significant reduction in the ALP level and Mayo score was noted with vancomycin. Both studies recruited patients with and without IBD, but there are some promising early data that vancomycin may also play a role in treating PSC‐associated active IBD, particularly in children . A phase II trial aiming to recruit 102 adult participants with PSC, primary outcome setting at ALP reduction at 6, 12, and 18 months, is in process (no.…”

Section: Clinical Trials: Translating Precision Medicine Into Practicementioning

confidence: 92%

Precision medicine in primary sclerosing cholangitis

Maurice

Thorburn

2019

J of Digest Diseases

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Primary sclerosing cholangitis is a rare, complex autoimmune disease in relatively young patients. There is currently no treatment for the disease, resulting in high rates of advanced liver disease leading to death or liver transplantation. However, advances have been made in our understanding of the pathophysiological mechanisms of the disease, particularly from breakthroughs in the underlying genetics. Moreover, large international collaborations have generated important clinical data that have given greater detail on the different disease phenotypes and natural history, generating new risk prediction models. As a result, drug development may be designed to target specific disease mechanisms at known points of the disease natural history. Therefore, more drugs are entering phase II and III development, giving hope that soon patient‐specific treatments may be available to treat this difficult disease.

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Oral vancomycin induces clinical and mucosal remission of colitis in children with primary sclerosing cholangitis–ulcerative colitis

Cited by 36 publications

References 3 publications

Microbiome Responses to Vancomycin Treatment in a Child With Primary Sclerosing Cholangitis and Ulcerative Colitis

Microbiome Responses to Vancomycin Treatment in a Child With Primary Sclerosing Cholangitis and Ulcerative Colitis

Is Bartonella a Cause of Primary Sclerosing Cholangitis? A Case Study

Precision medicine in primary sclerosing cholangitis

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