The human bowel contains a complex population of bacteria containing hundreds of different species. The colon itself is densely populated with around 500 bacterial species and more than 30,000 subspecies of various normal bacteria. These organisms are a vital part of the gut flora ecosystem (or microbiota).
Bacteria and the chemicals they produce affect the body and these effects can have both positive and negative impacts on health. The human flora protects us from pathogenic or “bad” bacteria, however if a bad bacterium does implant itself into the population of normal healthy “good” bacteria, it can have a debilitating and sometimes toxic effect on our health. Due to the nature of the bacteria which are able to produce spores, it is difficult to remove the infection which can remain for many years or even a lifetime.
The use of healthy human donor flora implanted into the recipient appears to be the most complete probiotic treatment available today. It acts as a broad-spectrum antibiotic capable of eradicating “bad” bacteria and spores, whilst supplying the “good” bacteria for recolonization.
What is Faecal Microbiota Transplant (FMT)?
Faecal Microbiota Transplant (FMT) involves the infusion of healthy human donor faeces via endoscopic procedures, enema treatments and in some cases capsules into the bowel of the recipient, aiding the repair of the microbiome.
What does Faecal Microbiota Transplant (FMT) help with?
- Clostridium difficile Infection:
FMT is widely used to treat Clostridium difficile (C.difficile) infections, with centres worldwide offering FMT as a treatment for this condition. FMT boasts a cure rate of over 90% for C.difficile, which is far superior to what can be achieved with antibiotics1.
The Centre for Digestive Diseases is at the forefront of treating patients diagnosed with C. difficile using FMT.
- Ulcerative Colitis
FMT has been used to treat patients with Ulcerative Colitis (UC) unresponsive to standard therapy, with the Centre for Digestive Diseases having treated its first patient with UC using FMT in 1988.
Recent randomized controlled trials support our experience in clinical practice with published response rates in some studies using FMT to treat UC greater than 50%1.
- Irritable Bowel Syndrome
In our experience FMT may help symptoms of Irritable Bowel Syndrome (IBS) however, this not guaranteed. A recent randomised, double-blind, placebo-controlled study using FMT to treat IBS found FMT to be an effective treatment4, although FMT is not yet widely used to treat this condition.
Do I need to find my own donor?
No, you do not need to find your own FMT Donor. Donor selection and screening is a rigorous process which aligns with the Therapeutic Goods Administration (TGA) Standard for Faecal Microbiota Transplant Products (TGO 105). Donors must also adhere to a whole food, high fibre diet and commit to a healthy lifestyle that promotes wellbeing. This makes sourcing your own Donor very difficult.
Whilst under care at the Centre you will be provided with Donor Bank FMT product for your duration of your treatment.
What tests or investigations are done before starting the FMT?
Every patient journey is different. Your Gastroenterologist will take into consideration your condition, presenting symptoms and previous tests before making a decision about what other diagnostic investigations which may be needed. Often a panendoscopy, colonoscopy, blood and stool tests are helpful as a starting point when considering if FMT may be beneficial for you.
Patients can also expect to do a panel of screening tests before starting FMT treatment. The blood and stool tests that we perform look for a variety of specific infections (for example enteric parasites, pathogenic bacteria and viruses) and known diseases (including HIV, Hepatitis, Cytomegalovirus, Epstein Barr, Syphilis, Toxoplasmosis, HTLV and Strongyloides) whilst general bloods (such as FBC, U&E and LFTs) provide us with a picture of your overall health.
Can I do Do-It-Yourself (DIY) FMT at home?
Stool is considered to be a biological product and as such there is risk that it may carry a variety of infectious diseases which could be transmitted via the FMT. It is impossible to tell without extensive screening, tests and investigations, whether someone has a disease or condition that you could catch if you do DIY FMT. This is the case even if you trust your donor and think that they look healthy and well.
Given the risks involved and the very strict regulatory requirements as set out in TGO 105, CDD does not endorse or facilitate DIY home FMT.
How long do I need to do FMT?
Every patient will be assessed by the gastroenterologist on an individual basis to determine the recommended number of FMT infusions that are likely to be required. The number of treatments will vary according to your underlying condition and the severity of symptoms that you are experiencing.
You could expect to do a minimum of 2 FMT treatments for an uncomplicated case of recurrent C.difficile whilst a patient with Ulcerative Colitis be prescribed up to 6 months of therapy. Your treatment regime will be discussed in depth during your pre-FMT consultations.
When will I know if it works?
It can take many months before seeing the full clinical response to FMT however, some people notice changes well before this.
Will I have to do it again?
Treatment options and alternatives would be discussed in depth with you at consultation but under certain circumstances (for example if you experience a flare or symptoms relapse), your Doctor may consider prescribing you further FMT.
References and Further Reading
1Kim, K.O. & Gluck, M. (2019). Fecal Microbiota Transplantation: An Update on Clinical Practice. Clinical Endoscopy, 52: 137-143. Doi: 10.5946/ce.2019.009
Link to Publication: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453848/pdf/ce-2019-009.pdf
2Costello, S.P., Soo, W., Bryant, R.V., Jairath, V., Hart, A.L. & Andrews, J.M. (2017). Systematic review with meta-analysis: faecal microbiota transplantation for the induction of remission for active ulcerative colitis. Alimentary pharmacology & therapeutics, 46(3): 213-224. Doi: 10.1111/apt.14173
Link to Publication: https://pubmed.ncbi.nlm.nih.gov/28612983/
3Paramsothy, S., Kamm, M.A., Kaakoush, N.O., Walsh, A.J., van den Bogaerde, J., Samuel, D., Leong, R.W., Connor, S., Ng, W., Paramsothy, R., Xuan, W., Lin, E., Mitchell, H. & Borody, T.J. (2017). Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet, 389(10075): 1218-1228.
Link to Publication: https://pubmed.ncbi.nlm.nih.gov/28214091/
4El-Salhy, M., Hatlebakk, J.G., Gilja, O.H., Kristoffersen, A.B. & Hausken, T. (2020). Efficacy of faecal microbiota transplantation for patients with irritable bowel syndrome in a randomised, double-blind, placebo-controlled study. Gut, 69: 859-867. Doi: 10.1136/gutjnl-2019-320411.
Link to Publication: https://gut.bmj.com/content/gutjnl/69/5/859.full.pdf
