What is Ulcerative Colitis (UC)?

UC is one of the two main forms of inflammatory bowel disease (IBD). The other main form of IBD is a condition known as Crohn’s disease. In UC, tiny ulcers develop on the surface of the colon lining and these may bleed or produce pus. The inflammation usually begins in the rectum and lower colon, but it may affect the entire colon. UC is a condition that causes inflammation and ulceration of the inner lining of the rectum and colon (the large bowel). Inflammation is the body’s reaction to injury or irritation, and can cause redness, swelling and pain.

How is a diagnosis made?

If you develop diarrhoea with bleeding and abdominal pain, your doctor may suspect you have ulcerative colitis and you will be asked to have further blood tests. Usually a colonoscopy is required to visualize the ulcers and biopsies may be required.

Why consider Human Microbiota Transplant (HMT) for symptoms related Ulcerative Colitis (UC)?

There are consistent changes to the gut microbiota in IBD patients. At a high-level, these changes may be characterized a decrease in the diversity of the gut microbiome, shifting into a state of imbalance (known as dysbiosis). HMT has been studied in patients with UC, producing positive results. In a published review of the data, 201 out of 555 (36%) UC patients achieved clinical remission after a course of HMT treatment with no major side effects observed. In a recent study published in 2017 done in Australia, 27% of UC patients benefited from FMT compared with 11% in the placebo group.

What does the Hong Kong HMT programme involved?

Our centre works closely with renowned gastroenterologists in the region. Our HMT treatment programme is based on protocols from our GI specialist advisors, while taking into account the specific needs of the individual. Our programme is designed to help you get relief and long-term benefit from the symptoms of your condition by restoring the balance of microbiota in your gut.

Programme Overview:

  • Patients will undergo HMT implants on five consecutive days, or on two sets of five consecutive days (10 days total) over a period of 2-3 weeks.
  • HMT implants may be delivered via enema, capsules oral formulation, or colonoscopy (additional fees required)
  • Prior to undergoing HMT therapy, individuals will undergo a bowel preparation consisting of either standard bowel prep or colonic water lavage.

Important note

The goal of Human Microbiota Transplant (HMT) is to help rebalance the gut microbiota, which may alleviate some of the symptoms of a GI-related condition. Ulcerative Colitis is a medical condition, which should be treated underneath the supervision of a medical doctor. Any adjustment to medication or prescriptions must be discussed with your supervising doctor. It is essential, therefore, for clients to obtain a referral letter before symptom-specific treatment can begin.

Further diagnosis details

Your doctor may ask to have further blood tests to test if you are anaemic and whether your illness has caused the level of protein to fall. In general, the greater the degree of anaemia and the lower the protein level, the more severe the inflammation is likely to be. Doctors also use special blood tests called ESR and CRP to give a measure of the degree of inflammation. You may be asked to give small samples of your bowel motions, to measure levels of faecal calprotectin, which is a marker of inflammation and to be sure there are no signs of any bowel infection.

Further microbiota details

In UC patients gut microbiome shifts, often these shifts include fewer bacteria in the Bacteroides and Lachnospiraceae groups (phyla), but more in the Proteobacteria and Actinobacteria groups (phyla). In addition, a decrease in a butyrate-producing bacterium, which is important in intestinal health, has been observed in patients with IBD. Therefore, researches around the world are exploring the efficacy and safety of FMT for UC patients2.

Article Abstract 1:

Fecal Microbiota Transplantation for Ulcerative Colitis: A Systematic Review and Meta-Analysis
. 2016; 11(6): e0157259. Published online 2016 Jun 13. doi:  10.1371/journal.pone.0157259

Twenty five studies (2 randomized controlled trials, 15 cohort studies, and 8 case studies) with 234 UC patients were included. Overall, 41.58% (84/202) patients achieved clinical remission (CR) and 65.28% (126/193) achieved clinical response. Among the cohort studies, the pooled estimate of patients who achieved CR and clinical response were 40.5% (95% CI 24.7%-58.7%), and 66.1% (95% CI 43.7%-83.0%). Most adverse events were slight and self-resolving. The analyses of gut microbiota in 7 studies showed that FMT could increase microbiota diversity and richness, similarity, and certain change of bacterial composition.

Article Abstract 2:

Single Delivery of High-Diversity Fecal Microbiota Preparation by Colonoscopy Is Safe and Effective in Increasing Microbial Diversity in Active Ulcerative Colitis.
Inflamm Bowel Dis. 2017 Jun;23(6):903-911. doi: 10.1097/MIB.0000000000001132.

Recent trials suggest fecal microbiota transplantation (FMT) with repeated enemas and high-diversity FMT donors is a promising treatment to induce remission in ulcerative colitis. Of the 20 patients enrolled in this study, 7 patients (35%) achieved a clinical response by week 4. Three patients (15%) were in remission at week 4 and 2 of these patients (10%) achieved mucosal healing. Three patients (15%) required escalation of care. No serious adverse events were observed. Microbiome analysis revealed that restricted diversity of recipients pre-FMT was significantly increased by high-diversity 2-donor FMP. The microbiome of recipients post-transplant was more similar to the donor FMP than the pretransplant recipient sample in both responders and nonresponders. Notably, donor composition correlated with clinical response.