Faecal microbiota transfer in patients with microscopic colitis – a pilot study in collagenous colitis

Abstract

Objectives

Faecal microbiota transfer (FMT) consists of the infusion of donor faecal material into the intestine of patients with the aim to restore a disturbed gut microbiota.

Methods

In this pilot study (NCT03275467), the effect of three repeated FMTs (day 0, two weeks, four weeks) was studied and followed up for six months in nine collagenous colitis (CC) patients, using two stool donors.

Results

Five patients had an active disease at the time of baseline sampling. The primary endpoint (remission at six weeks, defined as <3 stools whereof <1 watery stool per day) was achieved by two of these patients, and by one at eight weeks. Overall, in all nine patients, FMT did not result in a significant reduction of watery stools, assessed by daily diary. However, diarrhoea (assessed by gastrointestinal symptom rating scale) was significantly improved at four (p = .038) and eight weeks (p = .038), indigestion at eight (p = .045) and 12 weeks (p = .006), disease-related worries at four (p = .027) and eight weeks (p = .027), and quality of life at six months (p = .009). FMT resulted in an increased number of lamina propria lymphocytes, possibly indicating an initial mucosal immune activation. No serious adverse events, no systemic effects, and no changes in faecal calprotectin and psychological symptoms were observed.

Conclusions

FMT is able to improve symptoms in a yet undefined subset of CC patients. Further studies could help to characterise this subset and to understand if these results can be generalised to all microscopic colitis patients.

Keywords:

• Faecal microbiota transplantation
• microscopic colitis
• collagenous colitis
• gut microbiota

Acknowledgements

The authors want to thank Ida Svanerud, research nurse at the Department of Gastroenterology at University Hospital Örebro, for her help with performing the study and collecting samples and Seta Kurt for her help with the flow cytometry.

Author contributions

SH, JR, JB, EHH, RJB, and JK designed the study; JB and JK recruited patients; SH, JR, JK and RJB collected the data; SH, JR, AKK, GV and JK analysed data and performed statistical analysis; SH, JR and JK drafted the manuscript; SH, JR, JB, AKK, GV, EHH, RJB, and JK interpreted the data and critically revised the manuscript. SH and JR contributed equally. All authors have reviewed and approved the final version of the manuscript.

Disclosure statement

RB received personal fee from Microbiome Expert Board, Ferring A/S outside the submitted work. All other authors have no conflicts of interest to declare.

Additional information

Funding

Part of this study was funded by a project grant from the Faculty of Medicine and Health, Örebro University, to Julia König. The funding source had no involvement in the conduction of the study.