Role of Fecal Microbiota Transplantation in Treating Inflammatory Bowel Disease and Clostridium difficile Infection: Narrative Review 2745

• Published in: The American journal of gastroenterology Vol. 113; no. Supplement; p. S1526
• Main Authors: Qureshi, Zaheer A., Reyes, Sherry, Biswas, Sharmi, Bodepudi, Sri Lekha, Thomas, Stacey E., Altaf, Faryal
• Format: Journal Article
• Language: English
• Published: New York Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.10.2018
• Subjects: Antibiotics; Feces; Gastroenterology; Inflammatory bowel disease; Microbiota; Transplants & implants
• ISSN: 0002-9270; 1572-0241
• DOI: 10.14309/00000434-201810001-02744

Introduction: Fecal microbiota transplantation (FMT) is a therapeutic method where fecal microbiota from a healthy donor is transferred to a patient in the hopes of restoring normal, healthy microbiota of the gut. FMT is a promising treatment option for patients with medical conditions causing dysbiosis such as inflammatory bowel disease (IBD), Clostridium Difficile infection (CDI), metabolic syndrome, obesity, and irritable bowel syndrome. Over the years, studies were conducted to test its efficacy in other clinical conditions associated with normal bowel microbiome depletion. Methods: This narrative review summarizes the available efficacy and safety data on the use of FMT in IBD and C. diff patients. We completed an extensive literature search on PubMed, Google Scholar, Scopus, and Cochrane library electronic databases. Results: In most studies, patients received antibiotics before FMT. In studies retrieved, donors were related to recipients (relatives, friends, partners), whereas stool from unrelated donors was used less frequently. Pre-transplant screening procedures include serological testing for viruses (e.g., hepatitis A/B/C viruses, EBV, CMV, and HIV) and stool testing for C. difficile toxins, parasites, ova, and common bacterial enteropathogens. According to our search, several routes of administration were reported: enema, colonoscopy in seven studies, gastroscopy, nasojejunal tube, and nasogastric tube. Data support a positive effect of FMT on the outcome of IBD in at least some patients. In the majority of studies reviewed, IBD patients showed decreasing rates of remission/response over time. Our search shows FMT was well tolerated. Most common adverse events were abdominal pain, cramping, bloating, flatulence, increased stool frequency, and fever within days of transplant. The majority were self-resolving. Stool preparation is required for FMT with the minimum amount of stool infusate needed being 50g. Conclusion: Low recurrence rates of CDI and successful restoration of gut microbiota has proven FMT an innovative and popular treatment. Infectious Diseases Society of America and Society for Healthcare Epidemiology of America made updated guidelines in 2017 to recommend FMT for treatment of people with >2 recurrences of CDI despite standard antibiotic treatment. Successful FMT procedures can save the healthcare system thousands of dollars with fewer hospitalizations and frequent antibiotic prescriptions. Further studies focused on long-term outcomes and safety are also warranted.