Fecal transplantation (or bacteriotherapy) is the transfer of stool from a healthy donor into the gastrointestinal tract for the purpose of treating recurrent C. difficile colitis.
Fecal Transplantation: Why It’s Performed
Fecal transplantation is performed as a treatment for recurrent C. difficile colitis. C. difficile colitis, a complication of antibiotic therapy, may be associated with diarrhea, abdominal cramping and sometimes fever. If you are over the age of 65 and/or have chronic illnesses, you may be at higher risk for having more severe infection. Diagnosis is based on a stool DNA test that detects the organism.
If you are diagnosed, your doctor will treat the initial infection with an antibiotic that specifically targets the C. difficile organism. Antibiotics used for the treatment of this infection include metronidazole, vancomycin and fidaxomycin. In 30 percent of treated individuals, the infection returns within a few days or weeks after finishing the antibiotic course. Your doctor may choose to treat this first recurrence with another round of antibiotic therapy. However, in those individuals who continue to have recurrent C. difficile colitis, fecal transplantation is an option. A recent study published in 2013 in the New England Journal of Medicine showed that fecal transplantation is more effective than oral vancomycin in preventing further recurrences in individuals who have already had recurrent C. difficile colitis.
As of 2013, fecal transplantation is currently not routinely performed for indications other than recurrent C. difficile colitis. More research studies are still needed to determine if fecal transplantation should be performed for other clinical indications. Fecal transplantation for other clinical indications should be considered experimental, and performed only as part of a research study where your safety is closely monitored.
Fecal Transplantation: What to Expect
You will need to identify a potential donor prior to your fecal transplantation. Donors should not:
- Have had any antibiotic exposure in the past six months
- Be immunocompromised
- Have had any tattooing or body piercing in past six months
- Have any history of drug use
- Have any history of high-risk sexual behavior
- Have any history of incarceration
- Have recently traveled to endemic areas
- Have any chronic GI disorders, such as inflammatory bowel disease
A potential donor will need to be screened by their physician for infectious pathogens by undergoing the following tests:
- Blood tests: Hepatitis A, B, and C serologies; HIV; RPR
- Stool tests: Ova and parasites; C. difficile PCR; culture and sensitivity; giardia antigen
- Donors should be informed that their insurance company might hold them financially responsible for all testing required prior to transplant. It is best that they check with their primary care provider and/or insurance company.
Fecal Transplantation Procedure
Fecal transplantation is usually performed by colonoscopy and less commonly by nasoduodenal tube. During colonoscopy the colonoscope is advanced through the entire colon. As the colonoscope is withdrawn, the donor stool is delivered through the colonoscopy into your colon.
Before your procedure, you will need to follow specific preparation instructions. Your doctor will discuss them with you in detail.
- You will need to stop any antibiotic therapy two days before the procedure.
- You will need to follow a liquid diet followed by an enema or laxative preparation the night before your scheduled procedure.
- Tell your doctors if you have any allergies.
- Your doctor will instruct you regarding any prescription medication you take.
Make sure a responsible adult accompanies you on the day of the procedure to take you home after it is finished. When you arrive, you will register and give your medical history.
During the colonoscopy:
- We will insert an IV into your vein in order to administer fluids and sedatives.
Once the procedure is finished, you will need to recover from the sedatives. Your doctor will discuss the findings with you. Then you may go home, where you should rest for the remainder of the day.