Use of oral vancomycin in children with autoimmune liver disease: A single centre experience

Abstract

BACKGROUND Previous reports showed some beneficial effect of oral vancomycin treatment (OVT) in children with primary sclerosing cholangitis; conversely, the experience in patients with other autoimmune liver diseases (AILD), including autoimmune hepatitis (AIH) and autoimmune sclerosing cholangitis (ASC), is scant. AIM To assess the response to immunosuppressive treatment (IS) and to OVT in children diagnosed with AILD. METHODS Retrospective study of children diagnosed with AIH (normal biliary tree at cholangiography) and ASC (abnormal biliary tree at cholangiography) in the last 10 years. All underwent standard immunosuppressive therapy (IS), but non-responders received also OVT. Biochemical remission [normal aspartate aminotransferase (AST)] and immunological remission (normal IgG and negative autoantibodies) rates and Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) index were assessed and compared during the follow up. RESULTS 75 children were included [69% female, median age 10.5 years (5.6-13.4 years), AIH = 54, ASC= 21]. Sixty-three patients (84%, AIH = 52, ASC = 11) were treated with standard IS and 61 achieved biochemical remission, whereas 12 not responding to IS [16%, F = 75%, median age 13.5 years, (12.2-15.7), 10 with ASC] required OVT and 8 achieved biochemical remission. Overall OVT increased the biochemical remission rate of the whole group of AILD patients from 81% (61/75) to 92% (69/75). Median values of AST, alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) decreased significantly after OVT start ( P < 0.05). Complete normalization of livers enzymes (AST, ALT and GGT) was observed in 6/12 patients (50%). Decrease in SCOPE index score was reported in 5/12 patients (42%). At last follow up (median of 4.4 years, range 0.6-13.8 years) all 75 patients are alive, 6 (8%, 1 with ASC) successfully discontinued medications, 1 (with ASC) required liver transplantation. CONCLUSION Children with AIH and ASC respond well to IS treatment. OVT may represent a valuable treatment option to achieve biochemical remission in patients not responding to standard IS. These promising preliminary results suggest that a prospective study is indicated to define the efficacy of OVT in AILD.

Any Role for Microbiota in Cholangiocarcinoma? A Comprehensive Review

“…A recent study of liver samples showed that immune cell alteration, which is responsible for the occurrence of CCA, is higher in patients with PSC and active colitis than in patients with PSC and inactive colitis or PSC without colitis, suggesting a possible role of the microbiota in the association between colitis, PSC, and CCA etiopathogenesis in these patients [68]. In line with this hypothesis, these data may support the idea that antibiotics may represent a possible therapy for patients with colitis and PSC [76,77]. Indeed, treatment with oral vancomycin, which re-equilibrates the species of the gut microbiota, has been shown to improve liver enzymes and the natural history of biliary disease in patients with colitis and PSC.…”

Autoimmune Hepatitis in Children: A Single Center Experience: Descriptive Research

“…Bir çalışmada, oral vankomisin tedavisinin standart immünsupresif tedaviye yanıt vermeyen hastalarda biyokimyasal remisyon elde etmek için bir tedavi seçeneği olabileceği ve bu konuda ileriye dönük çalışmalara ihtiyaç olduğu belirtilmiştir. 29 Bir diğer çalışmada, anti-B hücre ve anti-CXCL10 tedavi denemelerinin yeni tedavi ajanları için umut verici olduğu bildirilmiştir. Bu bulgularla çoğu pediatrik hastayı ömür boyu immünosupresan tedavi ve bunların olumsuz yan etkilerinden kurtarmak için intrahepatik gen ekspresyonu ve klinik sonuçlarına ilişkinin gelecekte yeni çalışmalara ihtiyaç olduğu belirtilmiştir.…”

Sclerosing cholangitis in children with inflammatory bowel disease

“…V recentních studiích došlo k normalizaci transamináz a sedimentace u pacientů léčených perorálně podávaným vankomycinem v dávce 50 mg/kg/den, přičemž délka léčby byla variabilní. (2,20,21) Nicméně data týkající se jeho paušálního použití jsou zatím limitovaná.…”