Imagining a “poop transplant” is not an easy thought to anyone, not until you learn its potential in treating severe diseases. A fecal transplant is also known as fecal microbiota transplant (FMT) and is a medical procedure where a healthy stool from a donor is transplanted into a patient’s gastrointestinal tract (colon).
Fecal transplant is becoming a favorable option to treat patients with severe incurring C.difficile infections.
In this article, we learn the background and use of fecal transplantation, how it is performed, who needs it, and which regulations exist for fecal transplant in the United States.
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What Is A Fecal Transplant?
Some doctors refer to fecal transplant as bacteriotherapy, the treatment with bacteria. The FTM procedure’s origin comes from the fact that a typical human gut hosts millions of bacteria in a community called “Gut Microbiome”. These bacteria exist in your digestive tract to mainly help digest food. There is a harmful bacterium population within these millions of bacteria in the gut, causing irritable bowel syndrome (IBS), Crohn’s disease, and similar gut diseases. On the other side, some bacteria fight for you, good bacteria, who work to efficiently break down food and kill and clear the gut from harmful bacteria.
An unhealthy gut is one where the good bacteria lose the battle against the harmful bacteria, get outnumbered, and give ground for faulty digestion and colon infections. Usually, doctors intervene in such cases with antibiotics designed to kill harmful bacteria, yet this process is never perfect. The antibiotics also kill a population of good bacteria in the process. When you start eating again, the harmful bacteria regain their force quickly and win the gut-battle again. That is when stool transplant becomes an option.
Historically, Chinese doctors were the first to use fecal transplants in treating patients with food poisoning and diarrhea. One thousand seven hundred years ago, Dr. Ge Hong, a medical scientist, administered human fecal suspension – a yellow soup- orally to his patients [1]. Bedouins have also used a similar approach by consuming their camels’ stool to treat dysentery [2]. Modern fecal transplant procedures use colonoscopes to inject filtered bowel movement’s from a healthy donor into the patient’s colon. Some uncommon methods use a Nasoduodenal feeding tube or oral capsules [3].
Uses Of Stool Transplants
C.Difficile Infection
Stool transplants are most commonly used to treat clostridium difficile associated disease (CDAD, also known as CD infection (CDI) or C. difficile. It is a serious infectious complication common among patients in intensive care units. Acquiring the disease puts patients at risk of antibiotic usage, longer hospitalization, and immunosuppression [4]. In the United States alone, CDAD is responsible for 15,000 deaths every year [5]. In clinical trials, FMT was proven successful in treating incurring CDAD cases by a cumulative success rate of approximately 90%. The procedure has been performed safely, with only 5.7% reported minor adverse events like bloating and diarrhea [6]. Another independent study that included 20 patients confirmed the efficiency of using FMT in treating a relapsing C.difficile infection with no recorded adverse
IBS
Mild cases of irritable bowel syndrome (IBS) have usually been treated by diet and lifestyle regulation. While doctors use several medications to treat average and severe IBS cases, some recent studies showed improvements in IBS patients after undergoing FMT treatment. 90% of these patients showed improved defecation and decreased abdominal bloating after the treatment [8].
Extended Potentials Of FMT
The biological mechanism applied through FMT therapy was also considered in treating remission in Crohn’s disease showing benefits over sham transplantations [9]. Treatments using fecal transplant have demonstrated effectiveness with other conditions such as chronic fatigue syndrome, obesity, insulin resistance, metabolic syndrome, Parkinson’s disease, and autism [10].
Avoiding Risks Of FMT Procedures
Research on FMT confirmed the safety of the procedure [11]. Nevertheless, there are several recommended guidelines for both donor selection and pre-treatment patient preparations to avoid adverse events from a fecal transplantation operation.
Donor qualifications
Fecal donations could be from family members or stool banks like the non-profit openBiome. These are the most common remarks when screening a fecal donation [12]:
- The stool has to test negative for infections and drugs.
- The donor has not been taking antibiotics for at least a month before the procedure.
- The donor has checked clear of immune system diseases or inflammatory bowel diseases.
- The donor hasn't recently received blood donation, organ or tissue transplantation, or been in a needle sticking accident.
- The donor does not suffer from overweight, neurological diseases, or metabolic disorders.
- The donor has not been recently in endemic areas or involved in risky sexual behavior.
The transplantation receipt shall also check for several conditions before getting ready for the operation [13]:
- FMT is not recommended for patients on immune-suppression drugs, have recently had a bone marrow transplant, have cirrhosis (impaired liver function), or AIDS.
- The procedure is recommended for CDI patients who have relapsed infections three times despite adequate antibiotic treatment.
- The patient must be administered in a hospital because DIY-transplants put patients at high risk of serious infections.
- During the days before the operation, doctors recommend a liquid diet and prohibit patients from taking antibiotics that could interfere with the procedure.
The FMT procedure is considered expensive and may exceed $2000. While some FMT-administration components may be covered in health plans, most health insurance companies won’t fully pay for the procedure as it is yet not FDA-approved. In June 2019, the FDA issued a safety alert warning from the use of fecal transplantation. The warning referred to two individual cases of adults who developed invasive infections after receiving an investigational FMT coming from the same donor. The donated stools were not tested for ESBL-producing gram-negative organisms before use what was linked to the occurrence of multi-drug resistant organisms (MDROs).
What Is A Fecal Transplant? Summing Up
Once you overcome the icky feeling of it, following a physician’s recommendation of transplanting another person’s stool into your own gut can save your life. Even with an alternative capsule treatment, it is a hard pill to swallow. Nevertheless, the therapy has been proven efficient and safe. It is especially useful for severe relapsing CDI cases. Moreover, fecal transplants have shown encouraging results in treating other gastrointestinal, metabolic, and immunity disorders.
The FDA warning confirms that the procedure might only be an option for acute cases and must be performed under careful and strict screening conditions. FMT has to be administered under high-qualified physician supervision. Future studies are expected to give more reliable guidelines on donors’ screening and shade lights on further potential health benefits.
References:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895930/
[2] https://pubmed.ncbi.nlm.nih.gov/30384951/
[3] https://pubmed.ncbi.nlm.nih.gov/31301451/
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3696909/
[5] https://www.nih.gov/news-events/news-releases/clinical-trial-testing-fecal-microbiota-transplant-recurrent-diarrheal-disease-begins
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475090/
[7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4017893/
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755303/
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998149/
[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895930/
[11] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4895930/
[12] https://www.mdpi.com/2079-9721/8/2/9
[13] https://aga-cms-assets.s3.amazonaws.com/201951716551—CGHPDF_FMT.pdf
