Successful response of primary sclerosing cholangitis and associated ulcerative colitis to oral vancomycin may depend on brand and personalized dose: report in an adolescent

Buness, Cynthia W.; Johnson, Kevin; Ali, Ahmad H.; Alrabadi, Leina; Lindor, Keith D.; Miloh, Tamir; Cox, Kenneth L.

doi:10.1007/s12328-020-01296-0

Cited by 11 publications

(5 citation statements)

References 30 publications

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“…14 OV is gut-selective and multiple case reports have documented its use to be associated with biochemical improvement in patients with PSC. [15][16][17] Hey et al 15 reported improvement in liver enzymes with the use of OV in a patient with recurrent PSC. Buness et al 16 reported the normalization of liver enzymes after treatment with OV in a 15-year-old girl with PSC.…”

Section: Discussionmentioning

confidence: 99%

“…[15][16][17] Hey et al 15 reported improvement in liver enzymes with the use of OV in a patient with recurrent PSC. Buness et al 16 reported the normalization of liver enzymes after treatment with OV in a 15-year-old girl with PSC. Davies et al 17 reported a case of a 12-year-old girl with recurrent PSC who achieved biochemical remission and had a normal biopsy 3 years after treatment with OV.…”

Section: Discussionmentioning

confidence: 99%

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Complete Biochemical Remission With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis and High Serum Immunoglobulin G4 Levels

Sohal,

Kowdley

2024

ACG Case Rep J

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Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease characterized by intrahepatic and extrahepatic bile duct strictures leading to cirrhosis. A subtype with elevated serum immunoglobulin (Ig) G4 levels has been recently identified. Elevated IgG4 titers can be present in 9%–15% of patients with PSC. Currently, liver transplantation is the only effective treatment of PSC, although multiple medical therapies are under evaluation. We report a case of a young adult with PSC and elevated IgG4 levels who had marked serum aminotransferase elevation; the patient had an incomplete response to steroids but achieved complete biochemical remission after initiation of oral vancomycin.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Complete Biochemical Remission With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis and High Serum Immunoglobulin G4 Levels

Sohal,

Kowdley

2024

ACG Case Rep J

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“…Only a few case reports and case series have specifically examined vancomycin for treating PSC‐associated IBD. While the observations in these studies (improvement and/or normalisation of objective markers of mucosal inflammation including faecal calprotectin and endoscopic findings) are encouraging preliminary findings, they are limited by the lack of a comparator group and their small size ( N = 1, 6,11–13 3, 14 7, 15 8, 16 17 17 ). Moreover, paediatric data are sparse.…”

Section: Introductionmentioning

confidence: 93%

Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis‐associated inflammatory bowel disease (PSC‐IBD): A matched analysis from the Paediatric PSC Consortium

Ricciuto,

Liu,

El‐Matary

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundData on oral vancomycin for primary sclerosing cholangitis (PSC)‐associated inflammatory bowel disease (IBD) are limited.AimsUsing data from the Paediatric PSC Consortium, to examine the effect of vancomycin on IBD activity.MethodsIn this retrospective multi‐centre cohort study, we matched vancomycin‐treated and untreated patients (1:3) based on IBD duration at the time of primary outcome assessment. The primary outcome was Physician Global Assessment (PGA) of IBD clinical activity after 1 year (±6 months) of vancomycin. We used generalised estimating equations (GEE) to examine the association between vancomycin and PGA remission, adjusting for IBD type, severity and medication exposures. Secondary outcomes included serum labs and endoscopic remission (global rating of no activity) among those with available data and also analysed with GEE.Results113 PSC‐IBD patients received vancomycin (median age 12.7 years, 63% male). The matched cohort included 70 vancomycin‐treated and 210 untreated patients. Vancomycin was associated with greater odds of IBD clinical remission (odds ratio [OR] 3.52, 95% CI 1.97–6.31; adjusted OR [aOR] 5.24, 95% CI 2.68–10.22). Benefit was maintained in sensitivity analyses restricted to non‐transplanted patients and those with baseline moderate–severe PGA. Vancomycin was associated with increased odds of endoscopic remission (aOR 2.76, 95% CI 1.002–7.62; N = 101 with data), and with lower CRP (p = 0.03) and higher haemoglobin and albumin (both p < 0.01).ConclusionVancomycin was associated with greater odds of IBD clinical and endoscopic remission. Additional, preferably randomised, controlled studies are needed to characterise efficacy using objective markers of mucosal inflammation, and to examine safety and define optimal dosing.

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“…Interestingly, a recent case study reported a PSC patient on monotherapy with oral vancomycin, who achieved normalization of liver enzymes and resolution of UC symptoms with colonic mucosal healing. These improvements have persisted over 8 years, but the patient was sensitive to doses and vancomycin manufacturers' brands [72]. Vancomycin is a glycopeptide antibiotic with bactericidal activity against Gram-positive bacteria.…”

Section: Microbiome Profile and Ibdmentioning

confidence: 99%

Bile Acid Signaling in Inflammatory Bowel Disease

Bromke

Krzystek−Korpacka

2021

IJMS

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Inflammatory bowel disease is a chronic, idiopathic and complex condition, which most often manifests itself in the form of ulcerative colitis or Crohn’s disease. Both forms are associated with dysregulation of the mucosal immune system, compromised intestinal epithelial barrier, and dysbiosis of the gut microbiome. It has been observed for a long time that bile acids are involved in inflammatory disorders, and recent studies show their significant physiological role, reaching far beyond being emulsifiers helping in digestion of lipids. Bile acids are also signaling molecules, which act, among other things, on lipid metabolism and immune responses, through several nuclear and membrane receptors in hepatocytes, enterocytes and cells of the immune system. Gut microbiota homeostasis also seems to be affected, directly and indirectly, by bile acid metabolism and signaling. This review summarizes recent advances in the field of bile acid signaling, studies of inflamed gut microbiome, and the therapeutic potential of bile acids in the context of inflammatory bowel disease.

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Successful response of primary sclerosing cholangitis and associated ulcerative colitis to oral vancomycin may depend on brand and personalized dose: report in an adolescent

Cited by 11 publications

References 30 publications

Complete Biochemical Remission With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis and High Serum Immunoglobulin G4 Levels

Complete Biochemical Remission With Oral Vancomycin in a Patient With Primary Sclerosing Cholangitis and High Serum Immunoglobulin G4 Levels

Oral vancomycin is associated with improved inflammatory bowel disease clinical outcomes in primary sclerosing cholangitis‐associated inflammatory bowel disease (PSC‐IBD): A matched analysis from the Paediatric PSC Consortium

Bile Acid Signaling in Inflammatory Bowel Disease

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