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Oral vancomycin induces sustained deep remission in adult patients with ulcerative colitis and primary sclerosing cholangitis

de Chambrun, Guillaume Pinetona; Nachury, Mariac; Funakoshi, Natalied; Gerard, Romainc; Bismuth, Michaela; Valats, Jean-Christophea; Panaro, Fabriziob; Navarro, Francisb; Desreumaux, Pierrec; Pariente, Benjaminc; Blanc, Pierrea

European Journal of Gastroenterology & Hepatology: October 2018 - Volume 30 - Issue 10 - p 1247–1252
doi: 10.1097/MEG.0000000000001223
Case Report: Gastroenterology

Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology. The treatment of UC is challenging, especially when it is associated with primary sclerosing cholangitis (PSC), a chronic inflammatory disease of the bile ducts that affects around 5% of patients with UC, and leads to an increased risk of cholangiocarcinoma and colorectal cancer. Microbiota is considered to play an important role in the pathogenesis of UC, although the efficacy of antibiotics in this context is only limited and transient. Several studies have investigated the use of antibiotics for the treatment of PSC in adult and pediatric populations, with conflicting results. In this brief report, we describe the effect of oral vancomycin treatment in three patients with UC and PSC refractory to conventional and biologic therapies. All three patients achieved clinical remission and mucosal healing with vancomycin 500 mg twice a day administered orally. Maintenance treatment with oral vancomycin was well tolerated and led to sustained clinical and endoscopic remission in all three patients. Oral vancomycin also improved liver function tests in two patients who did not have pre-existing cirrhosis.

aGastroenterology and Hepatology Department

bDigestive Surgery and Transplantation Department, Montpellier University Hospital, Montpellier

cGastroenterology and Hepatology Department, Claude Huriez Hospital, University of Lille 2, Lille, France

dDepartment of Gastroenterology, Mersey Community Hospital, Tasmanian Health Service North West Region, Latrobe, Tasmania, Australia

Correspondence to Guillaume Pineton de Chambrun, MD, PhD, Gastroenterology Department, Saint-Eloi Hospital, Montpellier University Hospital, 80 avenue Augustin Fliche, F-34000 Montpellier, France Tel: +33 4 67 33 73 97; fax: +33 4 67 33 76 94; e-mail: g-pinetondechambrun@chu-montpellier.fr

Received March 5, 2018

Accepted April 30, 2018

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