Fecal Microbiota Transplantation

Past, Present and Future

Olga C. Aroniadis; Lawrence J. Brandt

Disclosures

Curr Opin Gastroenterol. 2013;29(1):79-84. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Fecal microbiota transplantation (FMT) re-establishes a balanced intestinal flora with resultant cure of recurrent Clostridium difficile infection (RCDI). FMT has also been used to treat other gastrointestinal (GI) diseases including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), and chronic constipation and a variety of non-GI disorders. The purpose of this review is to discuss the intestinal microbiota and FMT treatment of GI and non-GI diseases.

Recent findings: It is known that an imbalanced intestinal microbiota predisposes to CDI, IBD and IBS. The complex role of intestinal microbiota to maintain health, however, is a newer concept that is being increasingly studied. The microbiome plays an important role in cellular immunity and energy metabolism and has been implicated in the pathogenesis of non-GI autoimmune diseases, chronic fatigue syndrome, obesity and even some neuropsychiatric disorders.

Summary: FMT is a highly effective cure for RCDI, but increased knowledge of the intestinal microbiota in health maintenance, as well as controlled trials of FMT in a wide range of disorders are needed before FMT can be accepted and applied clinically

Introduction

Fecal microbiota transplantation (FMT), or infusion of a fecal suspension from a healthy individual into the gastrointestinal (GI) tract of another person to cure a specific disease, is best known as a treatment for recurrent Clostridium difficile infection (RCDI); FMT, however, also has been used successfully for inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), idiopathic constipation and a variety of non-GI diseases. Recent studies have shown that the intestinal microbiota plays an important role in immunity and energy metabolism and that an imbalance in our commensal intestinal bacteria can predispose to disease development.[1] Re-establishment of the wide diversity of intestinal microbiota via infusion of donor feces into the colon is the proposed mechanism by which FMT results in clinical improvement in patients with RCDI.

FMT is by no means a new therapeutic modality, however, it did not receive public attention until recently, after several studies were published showing that stool is a biologically active, complex mixture of living organisms with great therapeutic potential for Clostridium difficile infection (CDI)[2–4] and perhaps other GI[5–8] and non-GI disorders.[9,10] The revelations about the human microbiome being published by the Human Microbiome Project consortium is bringing the strength of science to clinical observation, thereby enhancing our understanding of the complexities of our intestine and stool.[11] The administration of human fecal suspension by mouth for patients with food poisoning or severe diarrhea was first reported in fourth century China by Ge Hong.[12] In the 16th century, Li Shizhen described use of a variety of stool products for treatment of diarrhea, fever, pain, vomiting and constipation.[12] In the 17th century, FMT was used in veterinary medicine and later termed 'transfaunation'.[5] The first use of fecal enemas in humans for the treatment of pseudomembranous colitis was reported in 1958 by Eiseman et al.[13]

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