Fecal Microbiota Transplantation

Most of the bacteria in the body live inside the large intestine. There are as many as 1,200 different bacteria species and at least 100 trillion bacteria inside the gut at any time. These bacteria are important in digestion and in keeping the intestine healthy. The good bacteria that live in the colon are called “normal flora” or “microbiota.” They help prevent bad bacteria from multiplying and causing problems.

Bacteria also help break down fiber. This is an important part of digestive health and preventing constipation. Normal bacteria also make vitamin K and vitamin B for the body.

The microbiota in the gut can be affected when a person takes a lot of antibiotics over a period of time. The antibiotics can “kill” off good bacteria in the gut that normally act as a barrier to bad bacteria that should not be in the body. This can lead to development of Clostridium difficile (C. difficile) infection. C. difficile infection can also be caused by inflammatory bowel disease or weakened immune system as a result of a medical condition or treatment.

What is fecal microbiota transplantation?

Although antibiotics are the main cause of C. difficile infection, it is actually treated using antibiotics and/or probiotics. Antibiotics are usually effective against C difficile infection, but may not be enough for patients who have recurring C. difficile that comes back again and again. In cases like these, your child’s doctor may recommend a fecal microbiota transplant.

A fecal microbiota transplant (also referred to as “fecal transplant” or “fecal bacteriotherapy”) is a procedure in which fecal matter (or stool) from a healthy person is transplanted into a person with a recurrent C. difficile infection. The healthy stool restores the “good” strains of bacteria and breaks the recurring C. difficile infection.

How is a fecal transplant performed?

Stool donors are healthy people who undergo blood and stool tests to look for any possible infections. The night before the stool donation, the donor takes a laxative and the fresh stool specimen is collected from the donor at home. It is brought to CHOC within six hours of the transplantation.

The receiving patient’s colon is cleansed just before the procedure to decrease the amount of C. difficile organisms. The donor stool is tested for disease, strained and then transplanted into the patient. The stool is then transplanted using a colonoscopy procedure, during which the doctor inserts the fecal matter into the cecum,

Is a fecal transplant safe and effective?

Most side effects are mild and include abdominal gurgling, gas and noise.

According to a study by the U.S. Department of Veterans Affairs published in the May 2015 issue of the Annals of Internal Medicine, fecal transplantation is effective with few short-term side effects. The study found that for recurrent infections caused by C. difficile, fecal transplant is successful 85 percent of the time. Fecal transplants also helped 55 percent of patients for whom standard drug treatments didn’t work.

It is not known if other materials are also transferred. Intense research is ongoing for fecal transplant with other diseases such as IBD, ulcerative colitis and Crohn’s disease.