title: Successful colonoscopic fecal microbiota transplantation for active ulcerative colitis: First report from India.
abstract: Forty-four-year-old male with ulcerative colitis (UC) for 11 years reported frequent relapse despite daily sulfasalazine 4 g, azathioprine 125 mg, and rectal 5-aminosalicylic acid. Repeated use of corticosteroids led to cataract. At enrollment, he was passing eight stools a day with blood with a Mayo score of 9 (3+1+3+2). Stool was negative for ova/cysts/acid fast bacilli and Clostridium difficile toxin assay. Rectal biopsy showed cryptitis, crypt abscess, and crypt distortion with no inclusion bodies, and cytomegalovirus DNA was negative. Following informed consent and approval from IEC, three sessions of fecal microbiota transplant (FMT) were performed at intervals of 2 weeks. The donor was a 34-year-old relative with no history of gastrointestinal illness, no use of antibiotics over 3 months, and free from transmissible disease as per standard protocol. At colonoscopy, 350 mL of blended and filtered donor stool, drawn into seven syringes of 50 cm3, was instilled from terminal ileum to sigmoid. Follow up sigmoidoscopy and rectal biopsy were done monthly for 6 months. There was symptomatic, colonoscopic, and histopathological improvement with the Mayo scores of 4.1 and 0 at 4.8 and 12 weeks post FMT. Azathioprine and sulfasalazine were tapered sequentially between months 4 and 6 of FMT. He remains in clinical and endoscopic remission 8 months after FMT and 2 months after withdrawal of all medication. Colonoscopic FMT may be effective in inducing drug-free remission in patients with active UC.
authors.affiliation: Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122 002, India. akseth2003@yahoo.com.
authors.forename: Avnish Kumar
authors.identifier: http://orcid.org/0000-0003-0792-6984
authors.initials: AK
authors.lastname: Seth
authors.affiliation: Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122 002, India.
authors.forename: Pawan
authors.initials: P
authors.lastname: Rawal
authors.affiliation: Department of Pathology, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122 002, India.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Bagga
authors.affiliation: Department of Pathology, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana, 122 002, India.
authors.forename: Priti
authors.initials: P
authors.lastname: Jain
mesh_terms: D000305:Adrenal Cortex Hormones; D000328:Adult; D001379:Azathioprine; D003093:Colitis, Ulcerative / Q000628:therapy*; D003113:Colonoscopy; D000069467:Fecal Microbiota Transplantation / Q000379:methods*; D006801:Humans; D007194:India; D008297:Male; D019804:Mesalamine; D012074:Remission Induction; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D019804:Mesalamine; D001379:Azathioprine
keywords: Fecal microbiota transplant; Ulcerative colitis