A four-week treatment with oral vancomycin led to clinical remission in PSC-IBD patients, accompanied by significant shifts in gut microbiota, reduced inflammation, and altered bile acid and short-chain fatty acid metabolism—effects that reversed upon treatment withdrawal.
Study:Â Open label vancomycin in primary sclerosing cholangitis-inflammatory bowel disease: improved colonic disease activity and associations with changes in host-microbiome-metabolomic signatures. Image Credit:Â TopMicrobialStock/Shutterstock.com
In a recent study published in the Journal of Crohn’s and Colitis, researchers showed that oral vancomycin (OV) induces clinical remission in primary sclerosing cholangitis-associated inflammatory bowel disease (PSC-IBD).
Around 2% to 14% of IBD patients develop PSC, and in turn, most PSC patients develop colonic IBD. The development of PSC in IBD patients is rare but is associated with elevated risks of colorectal cancer, colectomy, liver transplantation, hepatobiliary malignancy, and mortality.
While liver transplantation is the only life-extending intervention, one in three patients develop recurrent disease.
About the study
The present study explored the mucosal changes associated with clinical remission with OV in PSC-IBD. This single-arm, open-label, interventional study recruited adults with PSC and concomitant colonic IBD.
Patients were excluded if they had rectal, right-sided, or isolated ileal phenotype of PSC-IBD, active infectious cause of diarrhea, history of colonic resection, vancomycin intolerance, or used antibiotics, probiotics, or corticosteroids, among others.
At baseline, a colonoscopy was performed, the total Mayo colitis score was recorded, and about eight biopsies were collected from the sigmoid colon. Participants with active colitis were treated with 125 mg OV four times daily for four weeks.
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