A Ray of Hope in Ulcerative Colitis Treatment: ”Fecal Transplant” and ”Flora Transplant”
What is Colitis?
COLITIS is an infection and/or inflammation of the mucosal lining of the large intestine (colon). Due to this inflammation in the colon mucosa, swelling (edema), discharge, bleeding, and ulcers (wounds) may appear on the inner surface of the intestine.
The most common symptoms of COLITIS:
- Abdominal pain
- Abdominal cramps
- Frequent urge to defecate
- Diarrhea
- Mucous rectal discharge
- Rectal bleeding
- Anemia
- Bloody stool
- Mucous (slimy) stool
- Weakness, fatigue
- Exhaustion
- Fever
- Loss of appetite
- Weight loss
- Urgent need for defecation, etc.
COLITIS has many causes. These include autoimmunity, infections (viral, bacterial, parasitic, etc.), ischemia (impaired blood supply), radiation (secondary to radiotherapy), and drug-induced cases (antibiotics, chemotherapy drugs, etc.).
Diagnosis of COLITIS is often possible by listening to the patient’s history. Colonoscopy is the most effective diagnostic tool. During colonoscopy, both imaging and biopsy of the colon mucosa for microscopic pathological examination can be performed. Stool and blood tests are also used for diagnosis.
The main principle in COLITIS treatment is to eliminate the underlying cause if identified. The goal of all treatments is to reduce or completely eliminate inflammation.
Ulcerative Colitis is one of the most common forms of colitis.
What is Autoimmunity?
Autoimmunity is when our immune system, due to chronic exposure to attacks and excessive fatigue, loses its coordination and perceives our own tissues as ”harmful-foreign” and subsequently attacks them. Some autoimmune diseases include Ulcerative Colitis, Rheumatoid Arthritis, Polycystic Ovary Syndrome, Fibromyalgia, Hashimoto’s Thyroiditis, Depression, Asthma, Allergic Rhinitis, Psoriasis, etc.
What is Ulcerative Colitis?
Ulcerative Colitis is a chronic autoimmune disease classified under colitis cases, characterized by inflammation and ulcers (wounds) on the inner lining of the large intestine. The disease progresses through ATTACK (periods of increased symptoms) and REMISSION (periods of reduced or no symptoms) phases. The symptoms of Ulcerative Colitis vary depending on the severity of the disease, the patient’s overall health status, the extent of involvement, and the affected area.
Are There Subtypes of Ulcerative Colitis?
Yes. Ulcerative Colitis is classified as mild, moderate, or severe based on its clinical course.
Based on the affected area, it is categorized as follows:
- Ulcerative Proctitis (Involves the last 20-30 cm of the colon, known as the rectum)
- Proctosigmoiditis (Involves the last 45-55 cm of the colon)
- Left-Sided Colitis (Involves the last 80-90 cm of the colon)
- Extensive Colitis (Involves the last 130-140 cm of the colon)
- Pancolitis (Involves the entire colon)
At What Ages Does Ulcerative Colitis Appear?
It usually starts between the ages of 20-30.
Is There a Gender Difference in the Development and Course of Ulcerative Colitis?
There is no significant gender difference.
Are Genetic Factors Important in Ulcerative Colitis?
Many studies show that genetics play an important role in ulcerative colitis.
Who Is Most Affected by Ulcerative Colitis?
It is more common in people living in industrial areas. It is more frequently seen in those with chronic exposure to physical, chemical, biological, and radioactive pollutants. Consumption of processed foods is another risk factor. It is also more prevalent in people experiencing high levels of stress. Those who frequently use medications (especially antibiotics, chemotherapy drugs, and corticosteroids), those who suffer from frequent diarrhea, and individuals with limited access to clean water and food are more likely to develop the disease.
How Does Ulcerative Colitis Affect Quality of Life?
Chronic fatigue, pain, cramps, frequent bowel movements, and the resulting disruption of sleep quality lower the quality of life. It can also lead to declines in academic, social, and professional performance.
Can Individuals with a Genetic Predisposition to Ulcerative Colitis Protect Themselves from the Disease?
Yes, they can significantly reduce their risk. The most important preventive measure is for individuals with a family history of ulcerative colitis to avoid the triggering factors as much as possible.
What Is the Most Critical Factor in the Development of Ulcerative Colitis?
A decrease in the biodiversity of the digestive system flora is the most critical factor in the development of ulcerative colitis.
What Are the Symptoms of Ulcerative Colitis?
The most common symptoms of ulcerative colitis include abdominal pain, cramps, frequent urge to defecate, diarrhea, rectal discharge, rectal bleeding, anemia, bloody stool, mucus in stool, weakness, fatigue, fever, loss of appetite, weight loss, and urgent need for defecation.
Which Disease Is Ulcerative Colitis Most Commonly Confused With?
Ulcerative colitis is most often confused with Crohn’s disease.
Can Ulcerative Colitis Be Treated?
Yes.
What Happens If Ulcerative Colitis Is Not Treated?
Anemia, chronic fatigue, depression, decreased quality of life, lower academic performance, and an increased risk of intestinal perforation and colorectal cancer compared to the general population. Failure to treat ulcerative colitis may also facilitate the emergence of other autoimmune diseases.
Are There Any Diseases Associated with Ulcerative Colitis?
Autoimmune eye diseases, rheumatoid arthritis, depression, autoimmune skin diseases, food allergies, etc.
How Is Ulcerative Colitis Treated?
Today, the treatment of ulcerative colitis is examined in two parts: therapies aimed at suppressing the ACTIVE FLARE-UP (ATAK) phase and treatments designed to prolong the REMISSION (inactive disease) phase.
Paradoxes in Ulcerative Colitis Treatment
Ulcerative colitis is a multifactorial, autoimmune process. However, despite its multifactorial nature, all ulcerative colitis patients exhibit damage to the digestive system microbiota, reduced microbiota biodiversity, and an increase in pathogenic microorganisms in the colon.
The medications used in the treatment of ulcerative colitis can be categorized into four main groups: antibiotics, corticosteroids, immunosuppressants, and anti-inflammatory drugs. A common feature of all these medications, aside from suppressing the disease, is the harm they cause to the digestive system flora.
The underlying pathology that triggers the disease is damaged microbiota with reduced biodiversity, leading to loss of selective permeability in the intestines (Leaky Gut Syndrome) and, ultimately, the initiation of AUTOIMMUNE reactions. Restoring the damaged microbiota (FLORA) should form the basis of treatment. If flora damage is repaired, the need for other treatments is greatly reduced or eliminated entirely.
Microbiota (FLORA) damage can be repaired through a high-biodiversity microbiota transplant from a healthy donor. This transplant can be performed as either ‘Fecal Microbial Transplantation’ (FMT) or ‘Total Gastrointestinal Flora Transplantation’ (TGFT).
What Is Fecal Microbial Transplantation (FMT)?
FMT involves transferring processed fecal microbial material from a healthy, high-biodiversity donor to the patient’s colon. At least 200 grams of fecal microbial material should be transferred in a single session.
How Is Fecal Microbial Transplantation (FMT) Performed?
FMT is most simply administered through an enema via the anal route, effectively restoring the microbiota in the final 50-60 cm of the colon.
To maximize effectiveness, FMT can also be performed colonoscopically using four different methods:
- FMT from a single donor applied to a single anatomical region of the colon
- FMT from multiple donors applied to a single anatomical region of the colon
- FMT from a single donor applied to multiple anatomical regions of the colon
- FMT from multiple donors applied to multiple anatomical regions of the colon
Does Fecal Microbial Transplantation (FMT) Have Any Risks?
If performed by experienced teams, with pre-procedure screening of donors, proper sample testing, necessary precautions, and post-procedure monitoring for at least 2-4 hours in hospital conditions, FMT poses no significant risks.
How Many Times Should Fecal Microbial Transplantation (FMT) Be Performed?
FMT should be performed at least once, but ideally four times at one-week intervals.
What Is the Effectiveness of Fecal Microbial Transplantation (FMT)?
FMT restores adequate microbiota in about 25-30% of cases with a single session and 55-65% with four sessions, leading to significant and long-term symptom relief.
What Is Total Gastrointestinal Flora Transplantation (TGFT)?
TGFT involves restoring microbiota from the mouth to the anus by transplanting microbiota collected from approximately 30-45 different anatomical locations in a healthy donor’s digestive system to the equivalent locations in the patient’s system.
How Effective Is Total Gastrointestinal Flora Transplantation (TGFT)?
TGFT has an 85% success rate and provides lifelong benefits.
Assoc. Prof. Dr. Murat KANLIÖZ
General Surgery Specialist
We have published our clinical research and experiences on this topic in the American medical journal CUREUS. You can access the article via the following link:
Read the article on CUREUS