Retrograde colonic enema-based FMT safe, effective in childhood constipation

Fecal microbiota transplantation (FMT) can complement the use of retrograde colonic enema (RCE) in the treatment of children with intractable constipation, suggests a study. 

Some 110 children participated in this randomized, double-blind, controlled trial and received either FMT with RCE or placebo with RCE. All participants received RCE daily, followed by FMT treatment twice a week for 4 weeks, with a follow-up period of 12 weeks. 

The main outcome was spontaneous bowel movements ≥3 per week. The investigators calculated the risk ratio (RR) with 95 percent confidence interval (CI) and analysed changes in intestinal bacterial profile by BOX-PCR-based DNA fingerprinting and sequencing. They also examined adverse effects based on the patients’ symptoms. 

Twenty-two patients (40.0 percent) in the FMT with RCE group and 10 (18.2 percent) in the placebo with RCE group experienced ≥3 spontaneous bowel movements per week (net difference, 21.8 percent, 95 percent CI, 13.2–30.4; RR, 1.364, 95 percent CI, 1.063–1.749; p<0.05) at the end of the follow-up period. 

Both RCE and FMT improved bacterial diversity in the intestines of constipated children. Additionally, all adverse events observed were mild self-limiting gastrointestinal symptoms. 

“FMT enhances the efficacy of RCE, and the use of RCE-based FMT is a safe and effective method in the treatment of intractable constipation in children,” the investigators said.