Oral vancomycin is associated with less therapy intensification in adults with symptomatic inflammatory bowel disease and underlying primary sclerosing cholangitis

Abstract

Background Case reports describe the use of oral vancomycin therapy (OVT) in adult patients with concomitant symptomatic inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC). OVT is associated with a higher likelihood of IBD remission in pediatric IBDPSC patients. However, there are limited data on the association between OVT and IBD disease course in adult IBD-PSC patients.

Methods We retrospectively evaluated IBD therapy intensification in adults with IBD-PSC prescribed OVT at 2 centers. Subjects were stratified by time “on” and “off” OVT. Only those who spent a minimum of 12 months in each period were included. The primary outcome was the frequency of IBD therapy intensification events.

Results Of 31 patients initially considered, 22 met the inclusion criteria. Most patients (68.2%) had fewer or no intensification events while “on OVT” compared to those “off OVT”. OVT was associated with fewer therapy intensification events (1.7 vs. 6.7, P=0.021) and steroid prescriptions (0.6 vs. 3.2, P=0.013) per 10 person-years.

Conclusions OVT use is associated with less need for IBD therapy intensification in symptomatic IBD-PSC adult patients. Prospective trials of OVT in such patients are warranted.

Keywords Inflammatory bowel disease, primary sclerosing cholangitis, oral vancomycin therapy, disease activity

Ann Gastroenterol 2025; 38 (4): 409-414