Fecal Transplantation - Types and Procedures

What Is a Fecal Transplant?

The fecal transplant also known as fecal microbial transplant is a bacteriotherapy. This procedure involves collecting poop or stool from a healthy donor and the screened poop is injected into the receiver's colon. This results in better effects from the healthy bacteria present in the transplant and resolves issues caused by bad bacteria present in the colon. Mainly it is recommended for Clostridioides difficile or C. difficile infections. This procedure has been performed on both children and adults. It is considered a safe and simple procedure. The advanced technique involves using screened poop capsules for the fecal transplant.

What Are the Types of Fecal Transplants?

In most cases, a fecal transplant is performed by colonoscopy (a type of endoscopy that helps examine the inside of the large intestine, including the colon, anus, and rectum). The healthcare provider guides the colonoscope through the entire length of the colon and then it is withdrawn. While withdrawing a solution that contains donor feces is deposited in the colon.

A less common nasogastric method of delivering the poop is used. In this method, the tube is inserted into the nose that reaches the duodenum. This method requires no bowel preparation but has a higher risk of side effects like aspiration pneumonia.

Another method involves poop capsules that need to be swallowed or through an enema (injection of fluid into the lower bowel through the rectum).

How Does Fecal Transplant Work?

A fecal transplant involves stool insertion that is full of healthy bacteria in the colon. When the good bacteria are more, the bad bacteria that cause disease are held back. Along with this antibiotics wipe out the bacteria that make the individual sick and colon inflammation. But sometimes, these antibiotics can also clear up the healthy bacteria that keep the colon and body healthy. Disturbance in the bacterial balance can lead to bad bacteria taking over. These bad bacteria produce toxins that harm the colon, and inflammation and diarrhea result in colitis. A successful fecal transplant can restore the gut's healthy bacterial balance, which helps to fight the infection quickly and helps the body to produce resistance against C. difficile.

Who Needs a Fecal Transplant?

Fecal transplantation is a procedure done in individuals who suffer from C. difficile infection which causes inflammation in the colon and results in colitis. A fecal transplant is a great choice for conditions like autism, inflammatory bowel disease, and obesity. There is no scientific evidence on how safe and effective is fecal transplant for treating serious problems and complications of C. difficile.

Who Is Qualified as a Fecal Donor?

Depending on the procedure of fecal transplant, the individual receives a transplant from a bank carefully screened donor, a suitable donor for a fecal transplant should be:

• Donors should not be immunocompromised.

• Donors should not have been exposed to any antibiotic exposure for the past six months.

• There should be no risk of any infectious disease.

• Donors should not be detected by chronic gastrointestinal disorders, like inflammatory bowel disease.

The donor should be screened for:

• HIV.

• Syphilis.

• Hepatitis A, B, and C.

• C. difficile infection.

• Intestinal parasites such as giardiasis or worms.

• Other disease tests are recommended by healthcare providers.

What Preparation Are Required Prior to Fecal Transplant?

Prior to Fecal Transplant:

• All the medications taken by the individual should be informed to the healthcare provider.

• The healthcare provider would instruct you on a set of instructions that has to be followed carefully.

• A clear understanding and discussion of the medicines over-the-counter drugs, herbs, dietary supplements, and counter pills should be done with the doctor.

• A bowel prep regimen has to be followed before the procedure if the transplant is done by colonoscopy.

• Sedating medication is given if the transplant is given by colonoscopy or endoscopy.

How Is Fecal Transplant Done?

The healthcare provider would collect the donor's bowel movement and mix it well with saline solution. Then the strain is filtered through a filter. This results in a brown liquid that contains good bacteria. The health care provider injects the solution deep into the colon, using a long flexible tube called a colonoscope. This is usually an in-hospital procedure and medication is provided that would help to sleep during the procedure. Antibiotics are prescribed for two days before the transplant. And a liquid diet and the use of laxatives or enemas are done before the procedure. Loperamide is prescribed on the day of the procedure so that it keeps the individual from having diarrhea and helps to hold the received stools so the results would be effective.

Poop Capsules: This is a widely used method. A fecal transplant that comes in capsule form is a poop capsule. The healthcare provider places the capsule in the gut through the tube deep down in the belly. The capsule is prepared, screened, frozen, and placed inside little capsules. 15 capsules in a span of two days are given. This works well to clear up diarrhea from recurrent C. difficile.

How Is the Recovery After a Fecal Transplant?

Fecal transplantation is regarded as safe and well-tolerated. In most cases, the side effects are related to the delivery method of the transplant. Colonoscopy is the method used for stool transplant, the temporary side effects are:

• Cramping pain in the colon, due to air trapped during the procedure.

• Minor leakage of transplant solution through the anus.

• Bloating and intestinal gas.

• Constipation due to antidiarrheal medication.

Other rare serious side effects are:

• Pneumonia from fecal transplant delivered by nasogastric tube.

• Infection with another virus or bacterium from the donor stool occurs if the donor stool is not adequately tested and screened.

• Risks due to endoscopy and colonoscopy include tear or perforation, infection and bleeding, and risk of anesthesia.

Conclusion

Fecal microbiota transplant is the most commonly used safe, effective, and simple procedure. It is used in cases of infection caused by C. difficile bacteria. This procedure colonizes healthy gut bacteria and the treatment is more successful than regular antibiotic therapies. This procedure helps with many diseased conditions and infections of the colon.