Oral Vancomycin for treating IBD in primary sclerosing cholangitis: A systematic review

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Created On: 29/01/2025

Around 70% of individuals with primary sclerosing cholangitis also experience inflammatory bowel disease (IBD). This study sought to summarize the available literature on the safety and efficiency of oral Vancomycin in tackling IBD in cholangitis-affected people.

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Key take away

Orally administered Vancomycin is effective and safe to mitigate inflammatory bowel disease symptoms (such as diarrhea and hematochezia) in primary sclerosing cholangitis.

Background

Method

Using CINAHL, MEDLINE, Web of Science, Scopus, and Embase databases, a literature review was performed. The Cochrane Collaboration Risk of Bias Tool, Newcastle-Ottawa scale, and Murad scale were employed for determining the quality of randomized controlled trials (RCTs), cohort studies, case series, and case reports, respectively. In this systematic review, the outcomes evaluated encompassed clinical, biochemical, endoscopic, and histological responses or remission.

Result

From 1,725 issued studies, 9 case reports, 1 RCT, 7 case series, and 3 cohort studies were identified. The majority of research reported betterment in clinical IBD symptoms, including hematochezia (blood in stool) and diarrhea. Fewer studies encompassed objective data such as fecal calprotectin levels, endoscopic Mayo scores, and histological findings to support their findings. No cases of vancomycin-resistant enterococci infections were observed.

Conclusion

Oral Vancomycin appears to be a valuable therapeutic option for IBD management in certain primary sclerosing cholangitis patients. Future studies must focus on prospective data collection using standardized measures for symptoms, endoscopic findings, and histology. A well-powered RCT is warranted to better investigate Vancomycin's potential.