Fecal microbiota transplantation in children: Current concepts

Research output: Contribution to journalReview article

Abstract

Purpose of reviewAdministration of fecal material into the gastrointestinal tract, termed fecal microbiota transplantation (FMT), is increasingly recognized as an effective treatment option for recurrent Clostridium difficile infection (RCDI). The impact of FMT on host microbial communities and subsequent disease states has also been explored in recent years for conditions as varied as inflammatory bowel disease especially ulcerative colitis, metabolic diseases, such as diabetes, graft-versus-host disease in hematopoietic stem cell transplant recipients, and autism and autism spectrum disorders. The purpose of this article is to review the evidence for FMT as a treatment option in various pediatric illnesses.Recent findingsThe rate of C. Difficile infection is rising among children, and is associated with significant morbidity and disease, with recurrence in up to 20% of pediatric patients. Several randomized controlled trials evaluating the utility of FMT in RCDI in comparison to vancomycin have been published and demonstrate high rates of efficacy between 70 and 100%. In addition, the safety of FMT in the treatment of RCDI has been well described in the adult population, with several pediatric case series demonstrating similar rates of tolerability and adverse events. FMT in ulcerative colitis appears promising, especially with multiple infusions administered via the lower gastrointestinal tract. However, there are several limitations, including the lack of uniformity of protocols used, source of FMT, route of administration and the lack of standardization of concomitant therapies. The data on usage of FMT for other indications are preliminary and limited.SummaryFMT is recognized as an effective treatment option for RCDI and is increasing sought by parents. Although limited, pediatric studies to date on the use of FMT for RCDI demonstrate similar efficacy rates as in the adult population. FMT has been proposed as a treatment option for an increasing number of pediatric conditions, and additional studies are needed to delineate the efficacy of FMT outside of RCDI, as well as its short and long-Term impacts on human health.

Original languageEnglish (US)
Pages (from-to)623-629
Number of pages7
JournalCurrent opinion in pediatrics
Volume31
Issue number5
DOIs
StatePublished - Oct 1 2019

Fingerprint

Clostridium Infections
Clostridium difficile
Pediatrics
Ulcerative Colitis
Fecal Microbiota Transplantation
Therapeutics
Lower Gastrointestinal Tract
Metabolic Diseases
Graft vs Host Disease
Vancomycin
Autistic Disorder
Hematopoietic Stem Cells
Inflammatory Bowel Diseases
Population
Gastrointestinal Tract
Randomized Controlled Trials
Parents
Morbidity
Transplants
Safety

Keywords

  • Clostridium difficile infection
  • fecal microbiota transplantation
  • graft versus host disease
  • inflammatory bowel disease
  • microbiome
  • multidrug-resistant organisms

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Fecal microbiota transplantation in children : Current concepts. / Gurram, Bhaskar; Sue, Paul K.

In: Current opinion in pediatrics, Vol. 31, No. 5, 01.10.2019, p. 623-629.

Research output: Contribution to journalReview article

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abstract = "Purpose of reviewAdministration of fecal material into the gastrointestinal tract, termed fecal microbiota transplantation (FMT), is increasingly recognized as an effective treatment option for recurrent Clostridium difficile infection (RCDI). The impact of FMT on host microbial communities and subsequent disease states has also been explored in recent years for conditions as varied as inflammatory bowel disease especially ulcerative colitis, metabolic diseases, such as diabetes, graft-versus-host disease in hematopoietic stem cell transplant recipients, and autism and autism spectrum disorders. The purpose of this article is to review the evidence for FMT as a treatment option in various pediatric illnesses.Recent findingsThe rate of C. Difficile infection is rising among children, and is associated with significant morbidity and disease, with recurrence in up to 20{\%} of pediatric patients. Several randomized controlled trials evaluating the utility of FMT in RCDI in comparison to vancomycin have been published and demonstrate high rates of efficacy between 70 and 100{\%}. In addition, the safety of FMT in the treatment of RCDI has been well described in the adult population, with several pediatric case series demonstrating similar rates of tolerability and adverse events. FMT in ulcerative colitis appears promising, especially with multiple infusions administered via the lower gastrointestinal tract. However, there are several limitations, including the lack of uniformity of protocols used, source of FMT, route of administration and the lack of standardization of concomitant therapies. The data on usage of FMT for other indications are preliminary and limited.SummaryFMT is recognized as an effective treatment option for RCDI and is increasing sought by parents. Although limited, pediatric studies to date on the use of FMT for RCDI demonstrate similar efficacy rates as in the adult population. FMT has been proposed as a treatment option for an increasing number of pediatric conditions, and additional studies are needed to delineate the efficacy of FMT outside of RCDI, as well as its short and long-Term impacts on human health.",
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