Introduction:
A fecal transplant is a procedure in which the doctor places the stool from a healthy donor into the digestive system of an ill person. This procedure is also known as bacteriotherapy or fecal microbiota transplantation. A fecal transplant is done to restore the normal balance of bacteria in the digestive system.
Who Needs a Fecal Transplant?
A fecal transplant is performed as a treatment for recurrent Clostridium difficile infection. Clostridium difficile infection is a complication of some antibiotic therapy which may present as diarrhea and abdominal cramping. The typical treatment of Clostridium difficile infection is with antibiotics for 10 to 14 days. Occasionally, this infection can recur after the treatment is completed. A fecal transplant is a more successful treatment for recurrent Clostridium difficile infection than antibiotics. It clears up the infection quickly. Doctors have begun to test fecal transplants on people with ulcerative colitis, Crohn's disease, cirrhosis, obesity, diabetes, multiple sclerosis, and food allergies. These are done only for research purposes, and safety is to be considered.
How Does a Fecal Transplant Work?
Antibiotics are usually given to treat infections. Antibiotics clear the bacteria which cause the disease, but sometimes they also clear the normal bacterial flora of the gut, resulting in diarrhea and colitis. A fecal transplant puts a stool full of normal healthy bacteria in the gut.
Who Is a Potential Donor for a Fecal Transplant?
The doctor will carefully screen fecal transplant donors to ensure their digestive system and feces are healthy. Without proper screening, a donor may transmit serious diseases. A potential donor should be between 18 to 60 years of age.
A potential donor needs to undergo the following tests:
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Blood Tests: Hepatitis A, B, and C and human immunodeficiency virus (HIV).
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Stool Cultures: Stool tests and cultures to check for parasites and any other underlying conditions.
Donors should not:
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Be immunocompromised.
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Had any antibiotic exposure in the past six months.
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Have recent travel history to endemic areas.
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Have inflammatory bowel disease.
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Have a history of drug use.
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Had tattooing or body piercing in the past six months.
How Is a Fecal Transplant Performed?
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There are several methods for performing a fecal transplant.
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Fecal transplant is mostly performed through colonoscopy.
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The patient is asked to stop antibiotic therapy two days before the procedure.
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The patient is asked to follow a liquid diet the night before the procedure.
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An enema or laxative is given the night before the procedure.
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Inform the doctor about the medications the patient is taking and the allergy history, if present.
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An intravenous tube is inserted to administer fluids and sedatives so the patient does not feel pain or discomfort during the procedure.
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Colonoscopy: During a colonoscopy, a long thin tube (colonoscope) is inserted through the rectum and advanced through the entire colon. The donor stool is collected, mixed with saline solution, and strained using a coffee filter. The result is a brown liquid that contains good bacteria. Once prepared, it must be transplanted within six hours. As the colonoscope is withdrawn, the donor stool is delivered through the colonoscopy into the colon. The patient is given Loperamide to prevent diarrhea so that the donor stool is held and is more effective. A proton pump inhibitor is given to prevent the good bacteria from being killed by the stomach acids. The patient should be followed up for at least eight weeks in total.
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Enema: This method introduces the fecal transplant directly into the large intestine through an enema. The patient is asked to lie on the side with the lower body elevated. The transplant in an enema bag is inserted and allowed to flow into the rectum. A fecal transplant given by enema is less invasive and lower in cost than a colonoscopy.
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Nasogastric Tube: A nasogastric tube runs from the nose to the stomach. This procedure delivers liquid stool preparation to the stomach, which then travels to the intestines. A syringe is used for flushing the stool preparation into the stomach through the tube.
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Capsules: This is a newer type of fecal transplant that comes in capsule form. It is not widely used. The doctor places the capsule containing the screened donor poop in the gut. The patient will get 15 capsules over two days. It is effective to treat diarrhea from recurrent Clostridium difficile infection. It is the least invasive and can even be done at home.
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Upper Endoscopy: If a fecal transplant cannot be done through colonoscopy, it is done via upper endoscopy. The patient is given a sedative, an endoscope is inserted into the mouth, and the air is used to fully open the esophagus, stomach, and intestine. The stool is placed into the small intestine.
The patient may have diarrhea for a few days, but most people get relief from the gastrointestinal symptoms within 48 hours. It can take up to three months for the gut bacteria to resemble the donor. The success rate is lowest with the capsule method and highest with the colonoscopy method. It is not recommended to try a fecal transplant at home by self because without proper screening, and there is a risk of transmission of life-threatening infections.
What Are the Side Effects of a Fecal Transplant?
There are few side effects with the fecal transplant. The transplant can cause bowel issues and nausea. The effects are not serious and usually go away with time.
What Are the Contraindications for Fecal Transplant?
A fecal transplant is not recommended for people who are immunocompromised because of the following:
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Advanced liver disease such as cirrhosis.
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Human immunodeficiency virus (HIV) infection.
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Recent bone marrow transplant.
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Taking drugs that suppress the immune system.
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Patients with anaphylactic food allergy.
Conclusion:
A fecal transplant is safe when it is transferred from a healthy donor. Fecal microbiota transplants have become the most effective method of treating recurrent Clostridium difficile infection.
