Fecal Microbiota Transplantation (FMT)

Fecal microbiota transplantation (FMT), more commonly known as stool transplantation, is a procedure that involves collecting fecal matter, or stool, from a tested donor, and placing it in a patient to replace good bacteria that has been suppressed or killed. The procedure restores gut flora, which is the community of microorganisms that live in the digestive tract that supports many of the body’s systems and processes, including the immune system that is responsible for fighting off infection. These good bacteria can be killed or suppressed using antibiotics, allowing bad bacteria to overpopulate the colon.

Currently fecal microbiota transplantation is used to treat recurrent C. difficile colitis, an infection caused by the Clostridium difficile bacteria and a complication of antibiotic therapy.

C. difficile can cause debilitating, even life-threatening, diarrhea. While the initial infection may be treated with an antibiotic, in 30% of patients the infection will recur. Antibiotics may be used again, but in recurrent cases, fecal microbiota transplantation may be an option. A recent study in the New England Journal of Medicine showed that fecal transplantation is more effective than medication in preventing further recurrences in patients who have already had recurrent C. difficile.
Donor Information
Prospective donors with risk factors for HIV (human immunodeficiency virus) and viral hepatitis are excluded from donating. Those with significant gastrointestinal or autoimmune disease, or with a history of cancer are not acceptable donors. Donors who meet the criteria undergo blood testing for a range of infectious diseases, including HIV (human immunodeficiency virus), hepatitis A, B and C, and syphilis. They are also asked to submit a stool sample to be tested for bacteria (such as Salmonella and Campylobacter), parasites, and Clostridium difficile.
You will be prescribed antibiotics to take for at least 4 days before the procedure and these should be stopped the night before. You will be prescribed a laxative to take before the procedure. Your medical team will give you more detailed instructions.

Please let the doctor know about all medication that you are taking, including supplements and herbs. Generally, you can take all your medication as usual, but your doctor may recommend certain ones to be stopped before the procedure.
Fecal microbiota transplantation is done on an outpatient basis. You may be given a sedative to relax you during the colonoscopy exam. You will change into a hospital gown and an intravenous line will be inserted to give you medication. An endoscope will be inserted into your lower bowel through your anus. The transplant liquid will be passed through the endoscope into your body. You may feel bloated and have the urge to pass stool or wind. The procedure takes 30 to 40 minutes.
If you are given a sedative, you will need someone to take you home after the procedure. You should not drive after the procedure. You can eat and drink normally and should be able to carry out your normal activities 24 hours after the procedure. A follow-up appointment will be scheduled to assess the results of the procedure. You will probably have to provide a stool sample at the appointment.

Following the procedure you are very likely to have loose bowel motions and feel a little bloated – this is normal. If the procedure is effective, the gut often takes a few days to improve. Your stool frequency will gradually reduce and your stool will become more formed (less runny). After a week you should be passing a nearly normal stool. During this time you may have some stomach cramps, and/or feel nauseous.

Please consult your doctor or the Digestive Disease Center if you develop severe abdominal pain, a fever or pass large amounts of blood after the procedure.
There have been no documented cases of infection transmitted through fecal microbiota transplantation. However, stool is a bodily fluid so it is essential that thorough donor screening and testing is carried out. Donors must complete a screening questionnaire similar to those used at blood banks and for organ or tissue transplants.

Possible risks of fecal microbiota transplantation thus include infection, allergic or immune reaction, transmission of disease, and damage to your colon by the endoscope. The latter is rare, occurring in less than one in 1,000 procedures, but can cause an infection, bleeding or a perforation (tears) of the lining of the bowel. If a perforation occurs, you may require surgery to treat the problem.

There are no limitations for travel before or after the procedure.

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
What if the procedure is not performed?
Please discuss specific risks of not having the procedure done with your doctor.
Your doctors will already have tried different types or longer courses of antibiotics. This treatment is only available to patients where these standard therapies have been tried and not worked.

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