All About Fecal Transplants

As you may know, the digestive system is filled with healthy bacteria which is an important part of regulating gastrointestinal health. For patients with conditions like irritable bowel syndrome or inflammatory bowel diseases, their gut flora is completely out of sync. There may have been a solution to this problem – stool transplants.

Also known as fecal microbiota transplantation, this treatment is a lot like a mix between an organ transplant and a blood transfusion. In the process, you take healthy, properly tested fecal bacteria from a healthy person and simply give it to a patient. In cases of disease like Clostridium difficile infection (CDI), a fecal transplant is helpful in 9 out of 10 cases, which is important considering how fatal CDI can be.

Despite its effectiveness, FMT is not without controversy. The FDA has gone back and forth on the issue, but recently has reversed their decision to increase regulation, instead allowing physicians to administer FMT at their discretion. Let's take a look at the pro's and con's of FMT and see how it may benefit patients with IBD. However, it important to note that the bacterial changes in themselves are not the cause, even if infections may act as triggers.

How The Procedure Works

The idea of taking someone else's fecal matter may seem gross at first, but it really isn't when you understand the process. First, you must find a healthy donor, typically a family member of the patient. The sample is mixed together with saline, stool and sometimes fiber. Then, the healthy bacteria is implanted, usually via an enema or a colonoscope. In a lot of cases with CDI, 98 percent of patients recover clinically after just one or two treatments, proving that healthy bacteria helps to outnumber pathological and harmful organisms. This change also impacts inflammation.

This is promising, especially when you consider FMT's potential application to other inflammatory bowel diseases, especially severe irritable bowel syndrome. According to Medscape.com, "Postinfectious IBS has been reported in up to 30% of patients with acute gastroenteritis, suggesting that the pathogenesis of IBS may be intimately linked to an altered intestinal microbiota." Some of the other diseases FMT may treat include ulcerative colitis, Crohn's disease, constipation and even some neurological conditions.

While more work needs to be done, FMT may become an integral part of managing and healing patients. An article on MedScape.com, "Systemic Review: Fecal Microbiota Transplantation in the Management of Inflammatory Bowel Disease" showed intestinal microbiota is involved in the pathogenesis of inflammatory bowel disease (IBD). Fecal microbiota transplantation has been used for the management of IBD as well as infectious diarrhea. In their study, they found that about 19/25 had a reduction of symptoms, 13/17 ceased needing IBD medication, 15/24 had remission, and all cases (15/15) of C. difficile infection were treated with success.

Right now, research into treatment for these diseases, not including CDI, need more time. But it's promising that the FDA is loosening restrictions, and allowing physicians to do their job. It may be the most healthy way to implant complete microbes, as acidophilus or probiotics are not always complete enough for these patients. Best of all, it's relatively safe and won't damage the immune system or nutrition like some treatments, If FMT reduced the need for steroids or helped reverse some surgical situations, it would be incredible. However, don't be surprised if pharmaceutical lobby groups fight against this treatment until they develop a synthetic product that would resemble this treatment. It's fair to say that several pharmaceutical groups, specialist and surgeons have major investments in staying with the old and not moving to the new. It is our goal to change the landscape of these digestive aliments for our patients and provide the best options of healthcare.

If you have a type of inflammatory bowel disease, including irritable bowel syndrome, Crohn's disease or ulcerative colitis, contact us today. We would be happy to answer any questions and help you discuss treatment options.