Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10304
Peer-review started: August 5, 2016
First decision: September 21, 2016
Revised: November 1, 2016
Accepted: November 16, 2016
Article in press: November 16, 2016
Published online: December 21, 2016
The role of fecal microbial transplant (FMT) in the treatment of pediatric gastrointestinal disease has become increasingly popular among pediatric practitioners, patients, and parents. The success of FMT for the treatment of recurrent Clostridium difficile infection (RCDI) has bolstered interest in its potential application to other disease states, such as inflammatory bowel disease (IBD). FMT has particular interest in pediatrics, given the concerns of patients and parents about rates of adverse events with existing therapeutic options, and the greater cumulative medication burden associated with childhood-onset disease. Published literature on the use of FMT in pediatrics is sparse. Only 45 pediatric patients treated for RCDI have been reported, and only 27 pediatric patients with pediatric IBD. The pediatric microbiome may uniquely respond to microbial-based therapies. This review will provide a comprehensive overview of fecal microbial transplant and its potential role in the treatment of pediatric inflammatory bowel disease. We will discuss the microbiome in pediatric inflammatory bowel disease, existing adult and pediatric literature on the use of FMT in IBD treatment, and pediatric FMT trials that are currently recruiting patients. This review will also discuss features of the microbiome that may be associated with host response in fecal transplant, and potential challenges and opportunities for the future of FMT in pediatric IBD treatment.
Core tip: There is growing interest in fecal microbial transplant (FMT) for the treatment of pediatric inflammatory bowel disease (IBD). The therapeutic potential of bacterial therapies is intriguing. FMT is effective for treating recurrent Clostridium difficile infection, distinct microbial signatures in IBD continue to be described, and patients are increasingly looking for therapeutic options with lower rates of morbidity. This review describes existing adult and pediatric literature on the role of FMT in IBD, features of the IBD microbiome that may be associated with response, current trials, and the potential challenges and opportunities for the future of FMT in pediatric IBD treatment.