Oral vancomycin solution is superior to capsule in inducing clinical biomarker and endoscopic remission in children with atypical ulcerative colitis

Abstract

Aims: Atypical colitis (presenting reverse gradient colitis, backwash ileitis or rectal sparing) is associated with primary sclerosing cholangitis–ulcerative colitis (PSC). Oral vancomycin has been used to manage paediatric atypical colitis with/without confirmed PSC. Different preparations had shown different efficacy. We compared oral vancomycin solution to capsules in inducing remission in children with atypical colitis, while assessing other potential confounders. Methods: Children using oral vancomycin for at least 3 months to manage atypical colitis were retrospectively identified. Factors associated with colitis remission (Paediatric Ulcerative Colitis Activity Index [PUCAI], faecal calprotectin, colonoscopy and histology) were explored. Results: Of 32/48 children with elevated PUCAI, 27/32 achieved PUCAI < 10 (20/23 after solution vs. 7/9 after capsules, P =.520). Faecal calprotectin <100 μg/g was achieved in 35/48 (28/35 after solution vs. 6/13 after capsules, P =.022). Follow-up colonoscopy during treatment (n = 25) showed reduced Mayo from median 2 to 0 (P