Refractory ulcerative colitis stabilized by interval washed microbiota transplantation: less is more

Abstract

Ulcerative colitis (UC) is an autoimmune inflammatory disorder characterized by a relapsing and remitting course. The gut microbiota is implicated in the pathogenesis of UC. Fecal microbiota transplant (FMT) has been reported as a rescue therapy for refractory UC. The newly improved methodology of FMT was recently coined as washed microbiota transplantation (WMT) based on the automatic purification system and washing process. Colonic transendoscopic enteral tubing (TET) is a novel delivery of WMT within the whole colon. In this case, the patient with refractory UC underwent two different strategies of fresh FMT. The prior strategy conducted daily FMT through the percutaneous endoscopic cecostomy (PEC) tube for 60 days. We performed WMT every 3–35 months by colonic TET or gastroscopy. The patient was effectively responsive to both strategies. The repeated interval WMTs induced long-term clinical remission for the patient. The case encouraged the physicians to consider repeated interval WMTs into practice as a long-term treatment strategy for refractory UC. Moreover, we hope more physicians and researchers would be inspired to study clinical strategies, such as optimizing the frequency and interval of WMTs and the related delivering strategy.

Keywords:

• Fecal microbiota transplant
• washed microbiota transplantation
• ulcerative colitis
• transendoscopic enteral tube

Transparency

Declaration of funding

This work was supported by a grant from the National Natural Science Foundation of China (No. 81873548) and the Nanjing Medical University Fan Daiming Research Funds for Holistic Integrative Medicine.

Declaration of financial/other relationships

Faming Zhang conceived the concept of GenFMTer, transendoscopic enteral tubing, and related devices. Other authors declare that they have no competing interests.

Author contributions

Data analysis and interpretation, drafting of the manuscript: Yun Wang. Critical revision of the manuscript for important intellectual content: Bota Cui. Study concept and design and study supervision: Faming Zhang.

Acknowledgements

The authors thank Jie Zhang at China Microbiota Transplantation System for the data collection.