FMT for C diff colitis: How to introduce FMT
Fecal Microbiota Transplantation (FMT), commonly called fecal transplant, is the most effective intervention known for chronically relapsing, antibiotic resistant C diff colitis. There are many ways to introduce donor fecal microbiota to a C diff infected colon. Different methods of performing the transplants include enema, colonoscope, nasogastric tube, and encapsulation.
Two research groups have investigated the most common ways to introduce FMT, and how effective they are compared to each other. The first group was Ethan Gough et al. in the November 2011 article “Systematic Review of Intestinal Microbiota Transplantation (Fecal Bacteriotherapy) for Recurrent Clostridium difficile Infection” published in the journal Clinical Infectious Diseases. Here’s what they found:
• Of 72 C diff colitis patients given FMT by gastroscope or nasojejunal tube, 72.8% were cured without relapsing.
• Of 62 C diff colitis patients given FMT by colonoscope, 83.3% were cured without relapsing.
• Of 156 C diff colitis patients given FMT by enema or rectal catheter, 92.3% were cured without relapsing.
Similarly, Zain Kassam et al., in their April 2013 article “Fecal Microbiota Transplantation for Clostridium difficile Infection: Systematic Review and Meta-Analysis” found that lower GI FMT (enema, rectal catheter, colonoscope) led to a 91.2% resolution rate, while upper GI FMT (gastroscope, naso gastric or nasojejunal tube) led to an 80.6% resolution rate.
Lastly, Canadian infectious disease doctor Thomas Louie presented a poster called “Fecal Microbiome Transplantation (FMT) via oral fecal microbial capsules for recurrent Clostridium difficile infection (rCDI)” at the Infectious Disease Week in October 2013. The poster described preparing a fecal slurry like the type used for enema, colonoscope, or gastroscope instillation, then using serial centrifugation to extract the bacterial portion and triple encapsulating that. At that time, he reported a 27/27 cure rate with no significant side effects. So far in my practice, I have found the encapsulation method to be safe and effective as well.
Dr. Mark Davis, ND, Chairperson Fecal Microbiota Transplant Committee