Fecal microbiota transplantation (FMT) is an emerging proposed alternative treatment for several gastrointestinal disorders. Previous terms to describe this procedure include fecal bacteriotherapy, fecal microbiota therapy, fecal transfusion, fecal or stool transplant, fecal enema, intestinal microbiota transplant (IMT) and human probiotic infusion (HPI).
FMT has shown some effectiveness in the treatment of intestinal dysbiosis (microbial imbalances), such as inflammatory bowel disease (IBD), ulcerative colitis (UC), constipation, diarrhea, and Clostridium difficile infection (CDI). FMT is being investigated in animal studies as a method to treat obesity, by treating the patient with fecal microbiota from lean donors, as well as neurological disorders (such as anxiety or depression); or autoimmune disorders.
Studies reveal the most common utilization of FMT is the treatment of CDI, which is a frequent cause of diarrhea due to pseudomembranous colitis from taking antibiotics. Infections may become severe, refractory to treatment methods and, in some cases, likely to relapse. The antibiotics may alter the normal gastrointestinal flora, which protect the intestinal pathogenic bacteria.
FMT involves the restoration of the colonic flora by introducing healthy bacterial flora from a donor via a nasogastric/nasoduodenal tube, enema, or colonoscopy. The procedure may be done as a single or multiple infusions. Donors are generally a healthy close relative or partner to the patient, as they will have the exposure to some of the same bacteria, living in the same environment, and their stools will be a suitable match. Donors are tested for a wide variety of parasitic and bacterial infections, including hepatitis, human immunodeficiency virus (HIV), and syphilis. Genetic differences apparently do not play a role in the reported success of the treatment(s). Once treatment has been performed, the patient may require repeated stool testing to confirm eradication of CDI. Some patients are performing this procedure in the home setting without the direction of a medical provider. It has been reported an additional route of administration is enteric-coated capsules containing saline-filtrated freeze-dried solid stool from the donor.
FMT is not new, as the first use was reported in 1958, with a transplant done via enema in the U.S. The first FMT done by colonoscopy was reported in 2000.
A modified form of FMT had been investigated, known as the autologous restoration of gastrointestinal flora (ARGF) in 2009, which is a self-donation (autologous) of stool provided by the patient prior to medical treatment and stored by refrigeration. If the medical treatment creates intestinal dysbiosis, such as CDI, the stool sample is extracted with saline and filtered, and processed into an enteric-coated capsule, as described earlier. The theory is the replacement of the patient’s original normal gastrointestinal flora, creating a microbial balance.