Everyone’s talking about it: the POOP TRANSPLANT

By now I’m sure you have heard about poop transplants, officially called “fecal microbiota transplantation” or FMT. At first, you may have been completely grossed out or confused or perhaps intrigued… is this real? Does it work? And why would anyone go through this? Let’s answer some of the FAQs since one day soon... poop transplant will likely be a standard therapeutic option!

http://www.nature.com/articles/nrgastro.2011.244

http://www.nature.com/articles/nrgastro.2011.244

 

When would one consider fecal transplant?

The only appropriate indication at this time is in patients with severe and recurrent C. difficile infection who have failed multiple attempts at conventional antibiotic therapy.

But in the future, fecal transplant may be used in any diseases associated with alterations in the gut microbiome including:

IBS (irritable bowel syndrome): reduced microbial diversity + decreased Bacteriodetes

- IBD (inflammatory bowel disease): Reduced microbial diversity

http://www.gastrojournal.org/article/S0016-5085(13)01279-1/pdf

http://www.gastrojournal.org/article/S0016-5085(13)01279-1/pdf

- Obesity, metabolic syndrome, insulin resistance: Reversed Firmicutes:Bacteroides ratio

- Autoimmune disease (multiple sclerosis, idiopathic thrombocytopenic purpura)

- Chronic Fatigue Syndrome: reduced E Coli, overrepresented Enterococcus & Stretococcus

 

So who’s poop are you getting exactly?

Although initially family members and household contact donors were used, now there is a stool donor bank called Openbiome that offers rigorously screened, high-quality traceable poop. They put donors through a very lengthy assessment process including 200-question clinical evaluation, lab screening including over 30 stool and blood tests. Less than 3% of people actually qualify to become donors.  Finally, each sample gets a very detailed RNA sequence characterization.

 

How does the poop get transplanted?

Several routes of transplant have been reported but the optimal protocol is unclear although using colonoscopy appears to have a higher success rate than others.

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1.     Colonoscopy: For the patient, it's no different than getting your routine screening colonoscopy. After getting sedated, a colonoscope is used to spray the poop throughout the colon often starting at the end of the small bowel and including the entire colon. It has been proposed as the preferential route of delivery as it is dispensed under direct visualization to the desired areas and you can evaluate for severity of disease at the same time.

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2.     Nasogastric tube: This involves putting a thin tube down the nose so that fecal material can be delivered to the small bowel and make its way to the colon. This usually requires daily infusions for multiple days.

3.    Oral capsules: Previous studies have used up to 30 frozen capsules on two consecutive days.

4.     Enema: Not ideal, an enema usually only delivers its contents to the left side of the colon, which could possibly limit its efficacy. Not to mention its near impossible to retain an enema for 6 hours!

 

Is it safe?

In short, yes! The adverse effects are mostly the known & expected ones associated with the mode of delivery (colonoscopy, etc). General reported adverse eevents include abdominal discomfort and infection, talthough it has been suggested that FMT using full-spectrum microbiotia has a protective mechanism that prevents infection transmission (not seen with synthetic stool or probiotics).

 

Now that you understand what a poop transplant entails... perhaps the ick-factor has diminished? Keep your eyes open for more FDA approved indications and tons of research on this topic coming your way!