A novel treatment combining fecal microbiota transplantation with retrograde colonic enema demonstrated significant efficacy in treating intractable childhood constipation, according to a randomized, double-blind controlled trial.
In the 110-patient study at Shengjing Hospital in China, published in The American Journal of Gastroenterology, 40% of the children receiving the combination therapy achieved at least three spontaneous bowel movements per week after a 12-week follow-up period compared with 18.2% in the control group receiving enema alone (risk [RR] = 1.364, 95% confidence interval [CI] = 1.036–1.749, P < .05).
The trial enrolled children aged 4 to 14 years who had failed previous treatment regimens, including PEG treatment (mean duration = 6.2 months, mean initial dose = 0.88 g/kg/day) and Chinese herbal medicine. At baseline, participants averaged 1.26 to 1.37 bowel movements per week, with 63% to 73% experiencing large or scybalous stools and 54% to 69% reporting painful movements.
The treatment protocol involved daily retrograde colonic enema (RCE) using 3,000 mL normal saline administered in 8 to 10 rounds until fecal impaction cleared, followed by twice-weekly fecal microbiota transplantation (FMT) for 4 weeks. FMT preparation consisted of 62.5g stool in 30 mL saline, delivered via a 40 cm anal tube.
Posttreatment analysis showed spontaneous bowel movements increased to 3.92 per week (95% CI = 3.67–4.18) in the intervention group vs 2.09 (95% CI = 1.64–2.55) in controls. Secondary outcomes at follow-up showed significant improvements, with painful movements decreasing to 18.2% vs 50.9% in controls.
Microbiota analysis revealed predominant bacteria posttreatment were Bacteroidales, Escherichia, and Bifidobacterium in the intervention group compared with Bacteroidales, Escherichia, and Eubacterium in controls.
Adverse events were mild and included vomiting (3 patients in each group), abdominal distention (3 intervention, 5 control), diarrhea (1 intervention, 2 control), and bloody stools (2 control). No infectious complications or colonic perforations occurred.
The recurrence rate was 26.7% in the intervention group versus 23.1% in controls, though this difference was not statistically significant.
The authors declared having no competing interests.
