What is a Fecal Microbiota Transplant?
Fecal transplantation is the administration of a solution of fecal matter from a healthy donor into the intestinal tract of a recipient in order to directly change recipient’s gut microbial composition and confer a health benefit.
FMT can be performed in children and adults.
Research shows that fecal transplant can restore healthy bacteria in the lower intestine, which can help control C. diff and keep it from coming back. In some cases, FMT can be more effective than antibiotics for keeping C. diff in check.
History and Timeline
First Record:4th century in china-yellow soup was applied in cases of food poisoning and diarrhoea.
16th century: Chinese developed faeces derived products for GI complaints.
*Bedouin Groups: Consumed stool of their camels for bacterial dysentery.
1537-1619: -Italian anatomist and surgeon Aquapendante coined Transfaunation(Transfer of GI contents from a healthy to sick animal)
18th century: Paullini outline the therapeutic potential of human excretions.
*Antoni van Leeuwenhoek: Microscopy-stool contained microbes
*Metchnikoff: Fermented products in his diet-improved his general health—increased lactic acid bacteria(Lactobacillus Bulgaricus)
*Alfred Nissle: Isolated E.coli
FMT In Modern Science (1950-2000)
- Attempt to ameliorate damage to commensals
Stanley Falkow-Sampled faecal material from surgical patients before antibiotics administration.
- Convert the stools into pill form-Daily intake to half the study group.
- Eiseman-Treated 4 critically ill patients of PMC with fecal enamas- Complete recovery in all patients.
- The first documented case of confirmed CDI treated with FMT was reported in 1983.
- Earliest record of FMT for non-infectious origin-45 years old man with ulcerative colitis(Full and lasting clinical recovery )
Gut Microbiome
- Microbiota:Bacteria,Archaea,micro-eukaryotes and viruses that share human body space.
They all function in a commensal symbiotic or pathogenic relationship.
- Microbiome: Collective Genomes of these organism.
- Human Microbiota:Estimated to contain 10-100 trillion microbial cells.
- Intestinal Microbiota: Having largest and most diverse population.
Gut contains 1100 prevalent species and atleast 160 species per individual.
Composition of human gut microbiota varies according to:
- Sex,race and age
- Diet
- Location along the GIT
Metagenomic studies shows richness and diversity of bacterial species in the human is an indication of good health.
-Presence of particular group of bacteria has health advantages.
– Enhances metabolism,immune system,cancer resistence,endocrine signalling and brain functioning.
Normal Gut Microbiome?
STOMACH:0-10²
-Lactobacillus
-Candida
-Streptococcus
-H.Pylori
-Peptostreptococcus
DUODENUM:10²
-Lactobacillus
-Streptococcus
DISTAL ILEUM:107-8
-Streptococcus
-Clostridium
-Bacteriodes
-Actinomycinae
-Corynebacteria
JEJUNUM:10²
-Lactobacillus
-Streptococcus
PROXIMAL ILEUM:10³
-Lactobacillus
-Streptococcus
COLON:1011-12
-Clostridium groups iv and xiv
-Bacteriodes
-Bifidobacterium
-Enterobacteria
INDICATIONS OF FMT
PRIMARY INDICATION
(a)Reccurent or Relapsing CDI
>3 or more than 3 episodes of CDI (mild to moderate)and failure to respond with standard therapy for 6-8 weeks with or without an alternative antibiotic.
> Atleast 2 episodes of CDI resulting in hospitalization and associated with significant morbidity.
(b)Moderate CDI
CDI with no response to standard therapy for 1 week.
(c)Severe CDI
CDI with no response to standard therapy for 48 Hours.
Clostridium Difficile
- Most common cause of intestinal infection and diarrhoea
- Spore producing bacteria
- Gram positive,obligate anaerobic bacteria
- Spreads through faeco-oral route
- Pseudo-membranous colitis-Associated with prolong use of antibiotics
- Resistant to heat,acid and antibiotic.
- Spores od c.difficile survives for long on inanimate objects
FMT INDICATIONS OTHER THAN CDI
- IBD-UC/CROHN’S DISEASE
- IBS
- OBESITY
- METABOLIC SYNDROME
- TYPE 2 DM
- FATTY LIVER DISEASE
- HEPATIC ENCEPHALOPATHY
Important Reminder:
The information provided above is meant to be used as an informative guide for patients. For precise and individualized recommendations, please consult with one of our board certified gastroenterologists to discuss your symptoms.
For additional information or to book an appointment at the Aayushman clinic Gastroenterology Center, please feel free to reach out to our dedicated team by calling us at 8860291508. You can also schedule online or reach out to us via the Contact Us form.