Faecal microbiota transplantation with dietary therapy for acute colitis

Day, A.1,2, Bryant, R.1, Yao, CK.3, Costello, S.1

1Dept of Gastroenterology, The Queen Elizabeth Hospital, CALHN, SA Health, 2Dept of Nutrition & Dietetics, The Queen Elizabeth Hospital, CALHN, SA Health, 3Dept of Gastroenterology, Alfred Health, Victoria

 

Up to a quarter of patients with ulcerative colitis (UC) will develop acute severe ulcerative colitis (ASUC). Long‐term colectomy rates remain high (>50% at 3 years). Faecal microbiota transplant (FMT) is not yet routinely used to treat UC. Alterations colonic metabolism may contribute to UC pathogenesis. This case study explores FMT with a dietary strategy as a new treatment for ASUC.

A 19-year-old man presents with ASUC meeting Truelove and Witt’s criteria, and day 3 oxford criteria (>8 stools per day). He declined colectomy. Donor FMT with dietary prescription as salvage therapy was offered. Severe colitis (Mayo-3) to the descending colon was noted at colonoscopy. FMT was delivered to the cecum. A nutritionally replete dietary prescription (Figure 1.) was commenced. Comprehensive dietary education was provided. Repeat FMT was given via enema on days 3 and 7.

The patient improved rapidly; stool frequency reduced to 2-3 motions per day without blood after 2 days. At week 4, the patient was opening his bowels every second day. Flexible sigmoidoscopy demonstrated Mayo-1 colitis. At week 8, endoscopic (Mayo-0) and histological remission (absence of neutrophilic infiltrate) was seen. Dietary compliance over the 8-week period was excellent (per weighed food diaries). He remained in clinical remission at 6 months (faecal calprotectin 4 µg/g).

The prompt and durable efficacy of FMT as salvage therapy for ASUC may have been augmented by prescription of different dietary substrate and alterations in metabolic capacity of the microbiome. Further trials are warranted to explore this ASUC treatment option.


Alice Day

Alice is a Senior Research Dietitian at The Queen Elizabeth Hospital and PhD Candidate at The University of Adelaide. Alice completed her Dietetics degree with first class honours in the UK before returning to Adelaide in 2009 to continue working as a clinical dietitian predominantly within gastroenterology, surgical, and critical care services. Alice’s interest in gut nutrition research started with an honours project investigating the nutritional impact of nocturnal fasting in chronic liver disease and continued to develop through her work with patients.  Alice is currently undertaking PhD in diet and inflammatory bowel disease and is the primary investigator on a pilot dietary intervention study for people with ulcerative colitis, in collaboration with SA Health IBD Services and Monash University in Victoria. Alice is an active member of SA Gastroenterology Dietitians Network, Dietitians Crohns and Colitis Network Australia, and Australasian Society of Parenteral and Enteral Nutrition.

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