COMMENTARY

Top 10 Practice-Changing Articles of 2012: Gastroenterology

David A. Johnson, MD

Disclosures

January 16, 2013

In This Article

Long-term Follow-up of Colonoscopic Fecal Microbiota Transplant for Recurrent Clostridium difficile Infection

Brandt LJ, Aroniadis OC, Mellow M, et al
Am J Gastroenterol. 2012;107:1079-1087

Abstract

Effectiveness of Fecal Microbiota Transplantation

Clostridium difficile colitis is now the ninth leading cause of mortality from gastrointestinal diseases -- exceeding mortality from gastrointestinal hemorrhage, chronic hepatitis C virus (HCV) infection, acute pancreatitis, diverticular disease, and cholecystitis. Death from C difficile infection increased 230% from 2002 to 2009. With the rising incidence, refractory infection and multiple relapses have become common clinical problems. Treatment options have generally proven ineffective, with the exception of fecal microbiota transplantation (FMT). Several studies of FMT have found high cure rates. This report highlights the effectiveness of this approach: 74% of patients had resolution of diarrhea in ≤ 3 days, and diarrhea resolved in 82% and improved in 17% of patients in an average of 5 days after FMT. The primary cure rate was 91%. Seven patients either did not respond or had early recurrence of C difficile colitis (≤ 90 days) after FMT. Four patients were successfully treated with vancomycin, and 2 patients required repeated FMT. The secondary cure rate was 98%.

Viewpoint

Fecal transplantation is easy and now a well-established, rational, durable, safe, and acceptable treatment option for patients with recurrent or refractory C difficile infection.

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