Fecal Microbiota Transplantation (FMT)
Fecal Microbiota Transplantation (FMT) is a new treatment that has been shown to be over 90% effective for treating C. difficile infection in patients who had previously failed to recover with antibiotic therapy. During FMT, a fecal preparation from a carefully screened, healthy stool donor is transplanted into the colon of the patient. There are multiple routes of administration (e.g., via colonoscopy, naso-enteric tube, capsules), each of which has unique risks and benefits.
Though the mechanism has yet to be determined, it is believed that FMT works by repopulating the patient’s microbiome with diverse microorganisms that competitively exclude C. difficile.
In a healthy gut community, C. difficile is out-competed by many different bacterial species. However, receiving antibiotic treatment disrupts this ecosystem by killing those protective bacteria. C. difficile forms spores that are resistant to antibiotics. No longer outcompeted, this pathogen establishes itself in the gut and produces toxins that leave patients suffering from severe diarrhea, abdominal pain, and, often, fever. With an infusion of bacteria from a healthy donor’s stool, the C. difficile is again out-competed.
Researchers are also exploring FMT’s potential role for treating other gastrointestinal diseases, such as IBS and Crohn’s Disease. A small study (16 patients) was reported at Digestive Disease Week (DDW) 2017 with some limited positive results with FMT and IBS.
Although FMT is a powerful tool for treating C. difficile infection, there are also important risks. Stool is a complex living mixture of bacteria and other organisms. While stool donors can be carefully screened for known infectious agents, there is always a risk that the tests might fail to detect a pathogen. There are also procedural risks associated with receiving an FMT by colonoscopy or other methods of administration.
At this stage it is still early to consider FMT as a treatment option for IBS patients.
The Microbiome Health Research Institute, d.b.a. OpenBiome
Last updated on Jan 12, 2021