J Pediatr Gastroenterol Nutr. 2020 Nov 20. doi: 10.1097/MPG.0000000000002995.Online ahead of print.

Jelena Popov ^1 2, Emily Hartung ², Lee Hill ², Usha Chauhan ³, Nikhil Pai ^2 4

Author information

• ¹College of Medicine and Health, University College Cork, Cork, Ireland.
• ²Department of Pediatrics (Division of Gastroenterology), McMaster University Medical Centre, Hamilton, Ontario, Canada.
• ³Adult Digestive Diseases, Hamilton Health Sciences, McMaster University Medical Centre, Hamilton, Ontario, Canada.
• ⁴Farncombe Family Digestive Health Research Institute, Department of Medicine, McMaster University, Hamilton, Canada.

Abstract

Background: Fecal microbiota transplant (FMT) has gained attention for its role in the treatment of ulcerative colitis (UC). Acceptance of this treatment, particularly among children and their parents, is an important aspect of assessing its feasibility for pediatric inflammatory bowel disease care. To date, no studies have assessed FMT acceptance among pediatric patients who underwent FMT treatment. Here, we explored the perceptions and experiences of FMT in a population of pediatric UC patients who participated in a recent FMT pilot randomized controlled trial.

Methods: Children who received bi-weekly FMT treatments for six-weeks through a clinical trial (NCT02606032) and their parents participated in face-to-face, semi-structured interviews led by study investigators. Interviews were audiotaped, transcribed, and analyzed using validated qualitative research methods.

Results: Eight patients and eight parents were interviewed, with qualitative data summarized across four themes and 11 subthemes. The majority of participants perceived FMT as a "natural treatment" and cited lack of response to conventional medications and fear of medication side-effects as motivators for pursuing FMT. Pre-treatment, patients and parents expressed concerns regarding physical discomfort with FMT administration; post-treatment, most patients reported feeling "completely normal". Both patients and parents uniformly expressed interest in pursuing FMT again in the future if available. Convenience of medication therapies, and perceived naturality and efficacy of FMT were all endorsed.

Conclusions: This is the first study to describe pediatric and parent experiences receiving FMT. This information is valuable to develop and encourage future FMT trials involving children. Pre-treatment, concerns about FMT were common. Post-treatment, patients reported tolerance to FMT and a desire to continue receiving this therapy if available. Further trials of FMT in UC are needed. Investigators should include pediatric patients without concern of acceptance.