What’s a Fecal Transplant and When Is it Recommended?

06 April, 2020
A fecal transplant seeks to restore the intestinal microbial balance. It can be applied to both adult and pediatric patients with surprising success. In this article, discover all about it.

Fecal transplant or bacteriotherapy is an experimental (and controversial) treatment. It consists of transferring the intestinal microbiota of a healthy donor to patients who are suffering from a variety of diseases associated with colonic microbe alterations. Yes, it consists of ingesting the stool of a healthy donor.

Clostridioides difficile infection (CDI or C-diff): a success case of fecal transplant

Clostridioides difficile is a bacterium that lives in the environment. Many people who have C. difficile don’t have any problems. This is because experts know that the bacteria itself isn’t what causes disease.

Only under certain conditions does the bacteria release toxins, which cause ailments. A person with a C. difficile infection may experience diarrhea and abdominal cramps. In severe cases, the infection can cause dehydration or require hospitalization. Also, it can be life-threatening.

In 2018, approximately ten thousand patients received fecal transplants in the United States. This treatment isn’t new. In fact, a clinical practice guideline regulates it since 2013. Its application is indicated for patients who suffer from “recurrent or refractory” C. difficile infections.

In other words, patients who suffer from recurrent infections and don’t respond to antibiotics. In addition, since 2018, it’s been allowed for new cases in adults and children.

What’s a Fecal Transplant and When Is it Recommended?

The application of fecal transplant for any illness other than C. difficile infection is only possible in the context of a clinical trial.

The fecal transplant process

There are several ways to administer this treatment. The most common is through a colonoscopy by getting a donation from a stool bank. This procedure is very safe in general. In this regard, experts have reported only minor discomforts, such as bloating, gas, and low-grade fevers.

The stool comes from a stool bank, which operates like tissue banks do. Firstly, medical professionals examine the donor’s stool for potent disease-causing organisms. Also, they test the blood of the donor in a lab to rule out infectious diseases. Thus, the stool bank provides optimum material for transplantation.

Another option is for a doctor to perform the procedure with donors who are friends or relatives of the patient. This is an exception that allows doctors to use their experience and judgment.

The third way is through “stool-based products.” These are pills or administration systems that offer, for example, a combination of microbes, rather than the entire universe of microorganisms.

How well do fecal transplants work for C. difficile infections?

Each year, there are more than 450 thousand cases in the United States and 29,000 deaths. Of these, 20% of patients aren’t cured by antibiotic treatment and the infection returns again and again and again.

In these patients, including pediatric cases, fecal transplants have a cure rate of 80 to 90%, meaning that a single treatment will cure the vast majority of patients with recurrent infections. However, some patients require more than one transplant.

The possible complications of this treatment

Overall, it’s a safe and well-tolerated procedure that saves lives. It’s important to mention that patients shouldn’t try it at home. It should only be performed by a trained doctor, using carefully examined equipment.

What’s a Fecal Transplant and When Is it Recommended?

Unfortunately, fecal transplants can be dangerous. Feces are a mixture of undigested waste and a repertoire of beneficial microbes that will establish a new order in the intestinal ecosystem. However, it also consists of bacteria, fungi, and “less friendly” or potentially pathogenic viruses.

Fecal transplant to treat other diseases

Medical professionals use this procedure with relative success to treat conditions such as diabetes. In pediatric patients, medical professionals use it for inflammatory bowel disease. In clinical trials, medical professionals use it to treat diseases such as end-stage liver disease, Alzheimer’s, multiple sclerosis, various cancers, asthma, allergies, and heart disease.

Experts have associated all these diseases with alterations in the bacteria that make up our intestinal ecosystem.

The existence of stool super-donors

Finally, we should mention that the existence of super-donors, people whose feces achieve a success rate of perhaps twice the average in the clinical improvement of patients, has surprised experts.

  • McDonald, L. C., Gerding, D. N., Johnson, S., Bakken, J. S., Carroll, K. C., Coffin, S. E., … & Loo, V. (2018). Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clinical Infectious Diseases, 66(7), e1-e48.
  • Wilson, B. C., Vatanen, T., Cutfield, W. S., & O’Sullivan, J. M. (2019). The super-donor phenomenon in fecal microbiota transplantation. Frontiers in cellular and infection microbiology9, 2.
  • Wang, A. Y., Popov, J., & Pai, N. (2016). Fecal microbial transplant for the treatment of pediatric inflammatory bowel disease. World journal of gastroenterology22(47), 10304. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5175243/