What is Fecal Microbiota Transplant?

Fecal Microbiota Transplant (FMT) can be thought of as a super probiotic. Probiotics are “good” bacteria that we take orally. In FMT the "good" bacteria comes from the fecal material (i.e. poop) of a healthy human donor. This material is processed to allow the good bacteria and the bacterial byproducts to be made into a form that can be delivered to an unhealthy person's gastrointestinal tract. It can be delivered via several different routes including swallowing capsules, colonoscopy, enema, or nasogastric tube. 

FMT cdiff poop
FMT Fecal Transplant poop pills

What is FMT used for?

FMT is being used all over the world to treat a life-threatening GI infection caused by the organism Clostridium difficilebetter known as C.diff. This infection is the leading cause of infectious diarrhea in hospital settings and often runs rampant due to its contagious nature. It is also an increasingly urgent cause of death and disease in the United States, specifically in populations over 65 years of age. [i] The greatest difficulty in treating C.diff is that it is often antibiotic resistant. This is where FMT comes in. In one meta-analyis of eleven studies and 273 patients treated with FMT for antibiotic resistant C.diff, it was found to be between 90%-95% effective with no major adverse events reported.[ii] That is a pretty amazing number. Who knew poop could be so powerful?

 

FMT History

FMT is not a new therapy. The therapeutic concept has been used in humans for thousands of years with the earliest record found in China during the 4th Century.[iii] It is referred to as "golden soup" and used to treat gastrointestinal infections, the same way we use it today to treat Clostridium difficile or C.diff.  Its earliest published application within the United States was in 1958 when it was successfully used to treat four cases of pseudomembranous colitis.[iv] It has also been a standard in veterinary medicine as a method of treating gastrointestinal issues in animals as well.[v] The use of FMT fell out of favor when antibiotics were able to treat gastrointestinal infections effectively. However, with the increase in antibiotic resistant infections such as C.diff., the use of FMT has once again re-surfaced and it's more important now than ever. 

 

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References 

[i] Pardi DKS. Clostridium difficile Infection: New Insights Into Management. Mayo Clinic. 2012;87(11):1106-1117.

[ii] Kassam Z, Lee CH, Yuan Y, Hunt RH. Fecal microbiota transplantation for Clostridium difficile infection: systematic review and meta-analysis. Am J Gastroenterol. 2013;108(4):500-508.

[iii] Zhang, F., Luo, W., Shi, Y., Fan, Z., & Ji, G. (2012). Should we standardize the 1,700-year-old fecal microbiota transplantation? The American Journal of Gastroenterology, 107(11), 1755; p.1755–6.

[iv] Eiseman, B., Silen, W., Bascom, G. S., & Kauvar, A. J. (1958). Fecal enema as an adjunct in the treatment of pseudomembranous enterocolitis. Surgery, 44(5), 854–859.

[v] Garcia-Mazcorro, J. F., Chaitman, J., Jergens, A., Gaschen, F., Marks, S., Marroquin-Cardona, A., … Weese, S. (2016). Commentary on key aspects of fecal microbiota transplantation in small animal practice. Veterinary Medicine: Research and Reports, 71.