Who may need a fecal transplant?
Fecal transplantation may be an option for people who have a C. diff infection in their colon that keeps coming back and is causing colitis (inflammation in the colon).
Although there is great interest in other possible applications of FMT for conditions such as inflammatory bowel disease, autism and obesity, there is no scientific evidence that fecal transplant is safe and effective for treating problems other than C. diff. Research on additional FMT uses is ongoing.
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Types of Fecal Transplantation Procedures
Fecal transplantation is usually performed by colonoscopy. A gastroenterologist guides the colonoscope through the entire length of the colon, and, as it is withdrawn, the solution containing donor feces is deposited into the colon.
Less commonly, the transplant is delivered through a tube inserted through the nose that reaches into the duodenum, the area where the stomach connects with the small intestine. This method does not require bowel prep, but is associated with a higher risk of side effects such as aspiration pneumonia.
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Sometimes, FMT can be delivered by a capsule that you swallow or through an enema.
Fecal Transplant Donors
Depending on how your doctor performs FMT, you might receive a transplant from a bank of carefully screened donors, or choose your own donor.
A suitable donor for fecal transplantation is a healthy adult who:
- Has not had any antibiotic exposure in the past six months
- Is not immunocompromised
- Is not at risk for infectious disease
- Does not live with any chronic gastrointestinal disorders, such as inflammatory bowel disease
A potential donor will need to be screened by their physician for:
- Hepatitis A, B, and C
- HIV
- Syphilis
- Intestinal parasite infections such as giardiasis or worms
- C. difficile
- Other diseases as the doctor recommends
Your physician will let you know the tests you will need as a donor or recipient of FMT.
Preparing for a Fecal Transplant
- Make sure your doctor is informed of all your medications and any allergies you may have.
- Before your procedure, your doctor will give you specific preparation instructions and discuss them with you. It’s very important to follow the directions carefully.
- You will need to stop all antibiotic medications two days before the procedure.
- Ask your doctor about all other medications you take, including over-the-counter pills, herbs and dietary supplements. The doctor will tell you if, when and how to take those medications as you prepare for your transplant.
- If your transplant is being delivered by colonoscopy, you will follow the bowel prep regimen for that procedure. Your doctor’s instructions may include a clear liquid diet and an enema or laxative preparation the night before your procedure.
- If the FMT is delivered by endoscopy or colonoscopy, you will get sedating medication. Make sure a responsible adult accompanies you on the day of the procedure to take you home after it is finished.
What Happens During a Fecal Transplant Procedure
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The FMT procedures differ depending on the transplant delivery method. For delivery through colonoscopy, the gastroenterologist prepares the transplant by taking the donor stool sample and mixing it with a saltwater (saline) solution. The fecal transplant is 100% liquid.
Once the transplant is ready, the doctor will place you on your side in an optimal position for colonoscopy, and you will receive sedating medicine. The doctor will guide a flexible tube with a camera called an endoscope or colonoscope through the anus into the colon all the way to where the large intestine meets the small intestine. As the doctor withdraws the scope, the fecal transplant solution is sprayed onto the walls of the colon.
After the procedure, you may return home or to your hospital room, where you should rest for the remainder of the day. Your doctor might have you take anti-diarrhea medication before you leave, to help keep the fecal transplant in your colon so it can do its work.
Recovery After a Fecal Transplant
FMT is regarded as safe and is well-tolerated, even by patients who are ill with C. diff and even by children. Most side effects have to do with the delivery method of the transplant. If you are receiving a stool transplant through the most common method (colonoscopy), you might experience temporary side effects such as:
- Bloating and intestinal gas
- Cramping due to air trapped in the colon during the procedure
- Constipation due to anti-diarrhea medication
- Minor leaking of the transplant solution through the anus
Serious side effects are rare, but can occur. These include:
- Infection with another bacterium or virus from the donor stool if the donor is not adequately screened and tested.
- Pneumonia from FMT delivered by tube through the nose (nasogastric tube).
- Standard risks from a colonoscopy or endoscopy, which include infection, bleeding, tear or perforation requiring surgery, and risks of anesthesia.
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