Definition: Fecal bacteriotherapy (FB) or fecal microbiota transplantation (FMT) is a type of therapy that has been used for many years, but is now starting to be looked at for its application in inflammatory bowel disease (IBD). FB is sometimes used to treat recurrent infections with Clostridium difficile (or C difficile), although this is not common.
The large intestine is teeming with many different types of bacteria. The composition or the number of the different types of bacteria could be altered by disease or by medication. A C difficile infection can occur when the bacterial flora in the large intestine is altered (usually by antibiotics), allowing the C difficile to proliferate and produce its toxins, which can cause severe and even life-threatening colitis and diarrhea. The typical treatment for a C difficile infection is a 10 to 14 day course of anti-C difficile antibiotics. Occasionally, C difficile colitis can recur after therapy is complete. It is for these refractory cases that FB has attracted the most attention.
FB is an emerging therapy that has not yet been used or studied extensively, but has been tried in some people who have recurring C difficile infections. The process starts with a close relative of the patient who is willing to collect their stool over a few days and donate it. The fecal matter is tested for anything that might prove harmful -- such as a disease, foreign bacteria or parasites. After the stool is determined to be safe for implantation, it can then be used for FB.
The fecal material could then be transplanted into the patient through an enema, a colonoscopy or a nasogastric (NG) tube. If given by enema, the fecal matter would be mixed with a liquid, such as saline, and given either by a doctor, or at home by a family member or the patient himself. An enema only extends so far up into the colon, so administering the transplantation via a colonoscopy is another method being used. When the procedure is done through a colonoscope, the fecal matter can be spread throughout the colon, which is thought to be more effective. When an NG tube (the most common method) is used, the fecal material can be distributed throughout the small intestine as well as the entire large intestine. A proton-pump inhibitor is usually given at the same time in order to prevent the beneficial bacteria from being killed by stomach acids.
One of the theories about the potential causes of IBD involves altered bacterial flora in the large intestine. It is thought that if people with IBD have a lack of some bacteria in the colon, or too much of another, FB could be a possible treatment. FB has only been researched for use in IBD in some small, preliminary studies, so the effectiveness is still not proven. One concern over the use of FB is the willingness of people with IBD to undergo the procedure. Some researchers did a small survey to find out if people with ulcerative colitis would consider FB, and the idea turned out to be favorably received.
Kahn SA, Gorawara-Bhat R, Rubin DT. "Fecal bacteriotherapy for ulcerative colitis: Patients are ready, are we?" Inflamm Bowel Dis 25 May 2011 DOI: 10.1002/ibd.21775. 31 Jul 2013.
Borody TJ, Warren EF, Leis S, Surace R, Ashman O. "Treatment of ulcerative colitis using fecal bacteriotherapy". J Clin Gastroenterol 2003 Jul;37:42-47. 31 Jul 2013.
Also Known As: fecal microbiota transplantation (FMT)