Article examines fecal microbiota transplantation

August 22, 2013

Fecal microbiota transplantation (FMT) has emerged as a highly effective treatment for recurrent Clostridium difficile (C. difficile) infection, with very early experience suggesting that it may also play a role in treating other gastrointestinal (GI) and non-GI diseases. The topic is examined in the Review Article, "An overview of fecal microbiota transplantation: techniques, indications, and outcomes" in the August issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the American Society for Gastrointestinal Endoscopy (ASGE). Also in this issue, the journal launches a new section called VideoGIE, which features high-quality videos of endoscopic procedures.

Fecal microbiota transplantation refers to the infusion of a suspension of fecal matter from a healthy individual into the GI tract of another person to cure a specific disease. FMT has received public attention recently with the publication of several studies showing that stool is a biologically active, complex mixture of with great therapeutic potential for Clostridium difficile infection and perhaps other GI and non-GI disorders. C. difficile is a bacterium recognized as the major causative agent of colitis (inflammation of the colon) and diarrhea that may occur following antibiotic intake. The disruption of the normal balance of colonic microbiota as a consequence of or other stresses can result in C. difficile infection. It is now estimated that 500,000 to 3 million cases of C. difficile occur annually in U.S. hospitals and long-term care facilities.

According to authors Lawrence J. Brandt, MD and Olga C. Aroniadis, MD, Montefiore Medical Center, Bronx, New York, current first-line treatment for C. difficile includes cessation of the culprit antibiotic, if possible, and treatment with , , or fidaxomicin, depending on . Most patients with C. difficile initially respond to this treatment, but recurrence rates are 15 percent to 35 percent. Patients who have one recurrence have up to a 45 percent chance of a second recurrence, and after a second recurrence, up to 65 percent of patients will have a third. Recurrences are usually treated with additional courses of metronidazole, oral vancomycin, or prolonged oral vancomycin in various pulsed-tapered regimens, occasionally "chased" by other antibiotics such as rifaximin. The high recurrence rates of C. difficile prompted the need for alternative therapies, to which the authors believe FMT offers a rational and relatively simple approach.

The Review Article addresses FMT methodology, including donor and recipient screening, donor selection, how FMT is performed and safety. FMT is most commonly performed via colonoscopy; however, donor feces also have been administered via a nasogastric or nasoenteric tube, gastroduodenoscopy, and enema. All the studies have reported remarkable cure rates without serious adverse effects directly attributable to FMT. The article notes that current literature on FMT for C. difficile predominantly comprises single-center case series and case reports, but also a meta-analysis, two systematic reviews, and one recently published randomized, controlled trial. In all, 92 percent of patients were cured of their recurrent C. difficile, with a range of 81 percent to 100 percent. In the only long-term follow-up study of FMT to date that included 5-medical centers and 77 patients who had FMT, the patients experienced a 91 percent primary cure rate and an astounding 98 percent secondary cure rate, the latter defined as cure enabled by use of antibiotics to which the patient had not responded before the FMT or by a second FMT. Patients in this study had symptoms for an average of 11 months before FMT, and most (74 percent) reported resolution of diarrhea within three days. FMT also has been successfully used to treat a variety of other GI disorders including inflammatory bowel disease, irritable bowel syndrome, and constipation. There is a growing literature on an altered intestinal microbiome in these and other disorders.

Explore further: Fecal microbiota transplants effective treatment for C. difficile, Inflammatory Bowel Disease

More information: www.giejournal.org/

Related Stories

Fecal microbiota transplants effective treatment for C. difficile, Inflammatory Bowel Disease

October 31, 2011
Growing evidence for the effectiveness of fecal microbiota transplants as a treatment for patients with recurrent bouts of Clostridium difficile (C.difficile) associated diarrhea is presented in three studies -- including ...

Fecal microbiota tx feasible for recurrent C. difficile in HIV

May 22, 2013
(HealthDay)—For HIV-infected individuals with recurrent Clostridium difficile infection, fecal microbiota therapy is feasible, according to a letter published in the May 21 issue of the Annals of Internal Medicine.

A new treatment option for Clostridium difficile: Fecal transplantation

March 14, 2012
Fecal transplantation through colonoscopy is an effective treatment for recurrent Clostridium difficile infection (CDI), according to a new study in Gastroenterology, the official journal of the American Gastroenterological ...

Fecal transplant feasible for recurrent C. difficile infection

March 3, 2012
(HealthDay) -- Recurrent Clostridium difficile (C. difficile) infection (CDI) can successfully be treated in the vast majority of patients through a fecal transplantation procedure via colonoscopy, according to research published ...

Groundbreaking clinical trial looks at fecal transplant as treatment for C. difficile

August 21, 2012
For patients with Clostridium difficile (C. difficile), a persistent and potentially deadly bacterial illness, severe diarrhea, abdominal pain, nausea and vomiting are an everyday event. This particularly virulent infection ...

Fecal microbial transplantation found to be possible treatment

April 5, 2013
A Spectrum Health clinical trial has found that fecal microbial transplantation (FMT) has resulted in the improvement or absence of symptoms in most pediatric patients with active ulcerative colitis.

Recommended for you

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

'bench to bedside to bench': Scientists call for closer basic-clinical collaborations

March 24, 2017
In the era of genome sequencing, it's time to update the old "bench-to-bedside" shorthand for how basic research discoveries inform clinical practice, researchers from The Jackson Laboratory (JAX), National Human Genome Research ...

The ethics of tracking athletes' biometric data

January 18, 2017
(Medical Xpress)—Whether it is a FitBit or a heart rate monitor, biometric technologies have become household devices. Professional sports leagues use some of the most technologically advanced biodata tracking systems to ...

Financial ties between researchers and drug industry linked to positive trial results

January 18, 2017
Financial ties between researchers and companies that make the drugs they are studying are independently associated with positive trial results, suggesting bias in the evidence base, concludes a study published by The BMJ ...

Best of Last Year – The top Medical Xpress articles of 2016

December 23, 2016
(Medical Xpress)—It was a big year for research involving overall health issues, starting with a team led by researchers at the UNC School of Medicine and the National Institutes of Health who unearthed more evidence that ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.