Fecal Microbiota Transplantation

Introduction:

Fecal microbiota transplantation is also known as a stool transplant, fecal transplant, intestinal microbiota transplant, or bacteriotherapy. It is a procedure in which the collected feces or poop, or stool from a healthy donor is introduced into the patient’s gastrointestinal tract. The first known description of therapy that uses feces was described during the fourth century in China by Ge Hong for the management of many conditions, including diarrhea. It was in 1958 when fecal microbiota transplantation was introduced in mainstream medicine by Eiseman and colleagues.

What Is Fecal Microbiota Transplantation?

Fecal microbiota transplantation is a procedure of administrating a solution of fecal matter from a healthy donor into the recipient’s gastrointestinal tract. This procedure is done to directly change the microbial composition of the recipient's gut and to present health benefits. Fecal microbiota transplantation can control clostridium difficile infection by adding healthy bacteria into the patient’s intestine. Research shows that in some cases, it can be more effective than antibiotics for controlling Clostridium difficile infection. Fecal microbiota transplantation can be performed in patients of all ages.

What Are the Functions of the Gut Microbiome?

Microbiota refers to microorganisms such as bacteria, viruses, archaea, and microeukaryotes that are present in the human body, and they may function in symbiotic, commensal, or pathogenic relationships. The microbiome is the collective genome of these species. The human microbiome shows variations in the composition of gut microorganisms based on sex, race, ethnicity, age, and diet. The diversity and richness of these microorganisms in the human gut can be an indicator of the health of an individual. The presence of certain microorganisms may provide health advantages. The functions include:

• Enhance metabolism.

• Cancer resistance.

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• Enhance the immune system.

• Improve brain function.

• Improve endocrine signaling.

Who May Need a Fecal Microbiota Transplantation?

Fecal microbiota transplantation is an effective procedure for people suffering from clostridium difficile infection that keeps coming back and resulting in inflammation of the large intestine or colon (colitis). The other possible applications of fecal microbiota transplantation are inflammatory bowel disease (chronic inflammation of the gastrointestinal tract), obesity, and autism (a condition involving problems with behavior and communication). But there is no scientific evidence of fecal microbiota transplantation being effective and safe for treating conditions other than clostridium difficile infection.

What Is Clostridium Difficile Infection?

Clostridium difficile is a bacterium that can cause infection of the colon or large intestine. A healthy human gut has a variety of microorganisms. Usually, these bacteria are harmless and help in digestion. However, many good bacteria in the human gut can get killed by treatment with antibiotics. This can allow the growth of bad bacteria such as Clostridium difficile. The symptoms of clostridium difficile infection are diarrhea, fever, and cramping. People generally get clostridium difficile infections after they are treated with antibiotics. Clostridium difficile infection can be severe and turn fatal in people of age above 65 and also in those suffering from chronic illness.

What Are the Types of Fecal Microbiota Transplantation Procedures?

• Through Colonoscopy - Fecal microbiota transplantation is often performed by using a colonoscope (a long thin, flexible tube with an attached camera). The colonoscope is guided through the entire length of the large intestine, and the solution containing the stool from the donor is deposited into the large intestine while the colonoscope is withdrawn.

• By Inserting Tube Through the Nose - It is the less commonly used method of fecal microbiota transplantation. In this method, the solution containing the donor’s feces is delivered through a tube that is inserted through the nose into the duodenum (the part of the digestive tract that connects the stomach to the small intestine). This method is associated with a greater risk of side effects like aspiration pneumonia (lung infection caused by inhaling gastric or oral contents).

• Through a Capsule or an Enema - Sometimes, fecal microbiota transplantation is delivered into the patient’s gastrointestinal tract by a capsule that the patient swallows or through an enema (a procedure that involves inserting liquid or gas into the rectum through the anus).

How Fecal Microbiota Transplantation Performed?

• Before the Procedure:

The patient should inform the doctor about all the medications he or she is taking and if they or suffer from any allergies. Before the procedure, the concerned doctor will discuss the whole procedure with the patient and gives specific instructions that need to be followed. The patient is asked to stop taking all the antibiotic medicines two days before the procedure. If the procedure is done through colonoscopy, then the patient would be asked to have a clear liquid diet and an enema or laxative preparation a night before the transplantation. The patient will be given sedatives if fecal transplantation is done through colonoscopy. So the patient should make sure to have a responsible adult accompanying them on the day of the procedure.

• During the Procedure:

The fecal microbiota transplantation procedures differ based on the delivery method of the transplant. For the transplantation through the colonoscopy, the doctor will prepare the transplant by taking the stool sample from a healthy donor and mixing it with a saline (saltwater) solution. The fecal transplant is a 100 % liquid solution. After the transplant is ready, the doctor will place the patient on the side in an optimal position for the colonoscopy and will give the sedating medication. The doctor will guide the colonoscope through the anus into the large intestine all the way to the duodenum. While withdrawing the colonoscope, the solution containing the fecal transplant is sprayed onto the walls of the intestine. The patient is shifted to a hospital room after the procedure is done or can return home. The patient is given anti-diarrhea medicine before he or she leaves the hospital. Anti-diarrhea medicine helps in keeping the fecal transplant in the intestine so it can do its work.

• Recovery After the Procedure:

Fecal microbiota transplantation is considered an effective, well-tolerated, and safe procedure. Most of the side effects are due to the delivery method of the transplant. If the transplantation is done through colonoscopy, the following temporary side effects can be seen:

• Intestinal gas and bloating.

• Cramping.

• Constipation.

• Minor leakage of transplant through the anus.

Conclusion:

Fecal microbiota transplantation is a procedure to transfer fecal bacteria from a healthy donor into the patient’s intestine. It is a safe and well-tolerable procedure. But it does have some side effects depending the type of delivering the transplant. Fecal transplantation is considered an effective treatment method in cases of clostridium difficile infection.