What is Fecal Microbiota Transplant?
Fecal Microbiota Transplant (FMT) is a procedure in which the fecal matter is collected from a tested donor, processed and then placed in a patient by colonoscopy, upper GI endoscopy or enema, depending on where the fecal matter is to be transplanted
Fecal Microbiota Transplant Procedure
The gut microbiota is the collection of microorganisms that live in the stomach and intestines. When healthy gut microbiota is altered due to antibiotic use or chronic gut disease like severe steroid refractory IBD, Clostridium difficile may proliferate and cause an infection that is difficult to cure; recent studies from India have also reported its beneficial effect in patients suffering from severe alcoholic hepatitis.
Stool from a healthy donor is made into a liquid mixture, filtered and transferred to a patient with recurrent C. difficile infection, severe inflammatory bowel disease or alcoholic hepatitis
This is a simple procedure and is performed usually by colonoscopy, less commonly by naso duodenal tube. The colonoscope is advanced right through the entire colon and as it is withdrawn the donor stool is released. The donor stool is processes and filtered before it is transplanted
What is clostridium difficile infections?
This is a serious infection, which is on the rise throughout the world. C difficile colitis occurs when antibiotic therapy is given and may be associated with diarrhea, abdominal cramps and fever. It is diagnosed by doing a stool DNA test which detects the bacteria. Initially, the C difficile colitis is treated with metronidazole, vancomycin and fidaxomicin. If the infection keeps recurring, fecal transplantation is considered
Who is a recipient?
- should have at least 3 episodes of mild to moderate C difficile infection that has not responded to 6-8 weeks of treatment with antibiotics
- at least 2 episodes of severe clostridium difficile needing admission
- severe infection that did not respond to antibiotics within 2 days
- Should not have any immunosuppressive disorders, cirrhosis of the liver or be on immunosuppressive drugs
- Donor should not
- have any antibiotics in the last 3 months
- be immunocompromised
- have any tattooing or body piercing in the last 6 months
- have a history of drug abuse
- have a history of high risk sexual behaviour
- have a history of any incarceration
- have travelled to endemic areas
- have any other gastro intestinal disorder such as IBD
Donor screening includes:
- Blood tests such as Hepatitis A, B, C and E serology, HIV serology, which should all be negative
- Stool for ova and cysts of parasites, C. difficile PCR, culture and sensitivity, giardia antigen
Side effects of Fecal Microbiota Transplantation
Recipient may experience
- mild and self-limiting abdominal discomfort or cramps
- diarrhea or constipation
- transmission of disease not tested in screening
Preparation of a recipient for FMT
- Should be on empty digestive system. Only clear fluids for 24 hours before procedure
- A bowel cleansing liquid may be advised. This is not to be taken by those suffering from severe infection, IBD, colitis, pseudomembranous colitis (infection in the colon; overgrowth of Clostridium difficile bacteria) or toxic megacolon
- May be advised tablet loperamide to reduce intestinal motility and thereby hold the transplanted bacteria
Preparation of the donor
- Donors should avoid any foods that the recipient is allergic to for five days before the transplant.
- Donation should be postponed if donor has fever, diarrhea or vomiting
- May be given a laxative the previous night
FMT is considered a success if the recipient has no relapses for eight weeks. Some patient’s may require several sittings to ensure a successful outcome