Fecal Transplantation for C difficile: A How-To Guide

David A. Johnson, MD

Disclosures

February 15, 2013

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In This Article

Fecal Microbiota Transplantation

Hello. I am Dr. David Johnson, Professor of Medicine and Chief of Gastroenterology at Eastern Virginia Medical School. Welcome back to another installment of GI Common Concerns -- Computer Consult.

Today's topic is fecal microbiota transplantation (FMT). A new Current Procedural Terminology (CPT) code [44705, "Preparation of fecal microbiota for instillation, including assessment of donor specimen"] has been assigned to FMT. Biotransplantation has recently come on the scene as a gastrointestinal procedure that can make a meaningful difference in patients with chronic Clostridium difficile infection (CDI).

FMT was used as early as the 4th century for acute diarrhea and food poisoning. Interest in FMT increased in the1980s when FMT was performed through a nasogastric tube. Long before its use in humans, FMT was used in animals, and the veterinarian literature is replete with uses for FMT.

FMT is now used as a treatment for chronic CDI, which has become an incredibly recalcitrant and relapsing disease. After a patient's first CDI, the likelihood of recurrence is 10%-20%. In a patient who has had a second CDI, the chance of recurrence is 40%-65%, and this risk increases to 85% following the third relapse. What can be done with these patients? The available treatments have not been very effective. Many of these patients are hospitalized and have life-threatening complications from CDI.

Effectiveness of Fecal Transplant for C difficile

We now have fairly strong evidence from a study of 77 patients from 5 centers around the country, which showed the effectiveness of FMT to be 91%-98% for achieving either a primary or secondary cure (after FMT, successfully treating patients who relapsed with antibiotics).[1] This study suggests that FMT may be an effective treatment for recalcitrant or relapsing CDI.

The American Gastroenterological Association (AGA) looked at these data and assembled a workgroup to develop guidelines for FMT, which were published in Clinical Gastroenterology and Hepatology.[2] If you are planning to do FMT, you should review this article.

The data on FMT were also presented by Dr. Larry Brandt[3] at the most recent American College of Gastroenterology meeting, in the American Journal of Gastroenterology lecture "Fecal Transplantation for Persistent C. difficile Infection," and were published online in the American Journal of Gastroenterology.[4]

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