Fecal Transplant

What is a Fecal Transplant?

For recurrent cases of C. difficile, a doctor may recommend bacteriotherapy, or a fecal transplant. Fecal microbiotica transplantation (FMT) involves transferring of healthy bacteria from a donor’s stool to a patient’s intestine to restore the proper balance of bacteria in the intestine so the immune system can be restored. Fecal transplant is quickly becoming accepted as a safe and effective treatment of C. difficile infection of the colon.

Why is a Fecal Transplant Done?

A person’s digestion depends on a delicate balance of healthy bacteria in your intestines. Sometimes, the good bacteria in one’s body can be disrupted by sickness or medication, and one may develop an infection caused by bacteria called Clostridium difficile or C. difficile, for short.

Symptoms of C. difficile are:

• Watery diarrhea
• Nausea
• Loss of appetite
• Fever
• Abdominal pain and tenderness   

Although C. difficile is rare, it can develop after taking antibiotics because of an illness. Antibiotics are very helpful in eliminating bacteria-related illness, but they are so powerful that they can eliminate the healthy bacteria in one’s digestive system as well. When the healthy bacteria are gone, people are more susceptible to developing a C. difficile bacterial infection. It is also possible to develop C. difficile if someone has been hospitalized and you are exposed to C. difficile spores. C.difficile can be very difficult to eliminate. If someone is diagnosed, the doctor will treat the infection with an antibiotic such as metronidazole, vancomycin or fidaxomycin that specifically targets the C. difficile organism. This treatment is effective for about 70 percent of patients. For the remaining 30 percent, the C. difficile infection returns within days or weeks after finishing the antibiotic. The doctor may suggest a second round of antibiotics, but sometimes the infection returns again. Should the infection return again or does not respond to antibiotics, then the doctor often recommends fecal transplant. FMT can cure c.difficle infection in over 90% of cases.

How Does One Prepare for a Fecal Transplant?

Preparing the Stool

• A laxative will be taken at bedtime a day prior 
• On the morning of the procedure, the donor will collect a fist-full sized amount of stool
• In order to dissolve and filter for particles, the specimen has to be diluted in saline
• For transport, it must be stored in a clean plastic container and be kept as cool as possible
• It is recommended that the stool be transplanted within 6 to 8 hours

Prior to the Procedure

• You will go over any medication you are currently taking with your doctor. It will be advised if you should stop taking any
• Several days before the procedure, you will need to stop taking antibiotics
• The prep may vary but is very similar to colonoscopy prep. Typically you will follow a two-day liquid diet in addition to laxatives to ensure there is no residual stool in your intestines
• Upon arrival at the endoscopy center, you will take two loperamide tablets (Imodium or a similar medication) to slow digestion

How is a Fecal Transplant Performed?

Most likely, you will be given a sedative through an IV to make you drowsy. The procedure is either performed using a colonoscopy or a nasoduodenal tube, which is inserted through the nose and extends to the small intestine. The most common process is by colonoscopy utilizing a colonoscope to advance through the entirety of the colon. As the scope is withdrawn, the donor stool is placed into your colon. Up to 500 ccs of prepared stool will be delivered into your right colon, and you should hold the stool for two to four hours or as long as possible.

What Happens After the Fecal Transplant is Done?

You will be monitored at the surgery center following the procedure. After the sedative wears off, your doctor will inform you of the outcome. You will most likely feel groggy from the medication and it will be recommended that you rest for the remainder of the day. You will need to have someone drive you home after the procedure. It is important that the stool transplanted remain in your intestine for as long as possible. Your doctor may give you over-the-counter loperamide or antidiarrheal medication. There will also be instructions provided relating to dietary needs. Depending on the doctor’s guidance, you may be able to resume regular activity the following day. A follow-up visit will be scheduled prior to leaving the endoscopy center.

What are the Risks Associated With a Fecal Transplant?

Because fecal transplants are a fairly new treatment, the true long-term effects are not well known. Some can have the following side effects: diarrhea, constipation, abdominal pain, or increased flatulence. Studies are currently being done by researchers to fully understand the long-term effects. 

Relating to the colonoscopy, risks are low but can include bleeding perforation (a hole or deep tear in the lining of the colon or rectum) which may require surgery, injury to other organs, and complications from the anesthesia.