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July 4, 2017

Fecal Microbiota Transplantation

JAMA. 2017;318(1):102. doi:10.1001/jama.2017.6466

Fecal microbiota transplantation, also known as stool transplantation, is a procedure in which stool from a healthy donor is placed into another patient’s intestine.

Candidate Patients for Stool Transplantation

Stool transplantation is used for difficult-to-treat or recurrent (3 or more episodes) Clostridium difficile infection. The intestines contain hundreds of types of bacteria. When the numbers of healthy bacteria decrease, often because of antibiotic use, harmful C difficile bacteria may proliferate and cause diarrhea. Although certain antibiotics treat C difficile, some individuals may not respond to these drugs; these patients may be helped by a stool transplant. Transplanting stool from healthy donors restores the balance of healthy bacteria and helps clear infection.

How Is Stool Transplantation Performed?

There are different ways to transplant stool, but in most cases, patients have a colonoscopy during which a health care clinician puts small amounts of liquefied and filtered stool into the colon. Other methods may be used, such as through a feeding tube, enema, or capsules.

Stool may be available from healthy volunteers, a family member, or a friend. Stool donors should be free of illnesses and undergo a thorough medical evaluation to ensure optimal health; blood tests for human immunodeficiency virus and hepatitis A, B, and C viruses; and stool tests for bacterial, viral, and parasitic infections.

Symptomatic patients may need to undergo therapy with antibiotics to manage C difficile, which are then stopped at least 24 hours before the procedure for most patients. Other antibiotics should ideally be discontinued.

It is not recommended to perform stool transplantation at home without guidance from a physician.

Side Effects

The side effects of stool transplantation include mild and self-limiting abdominal discomfort, cramping, bloating, diarrhea or constipation, and, rarely, transmission of diseases that cannot be tested for by screening. You should seek medical attention if you experience fever, severe abdominal pain or swelling, or vomiting or stool that contains fresh (bright red) or old (black) blood.

Other Uses and Insurance Coverage

Stool transplantation is being studied for treatment of other disorders such as inflammatory bowel disease, but its use in these conditions is limited to research settings.

The US Food and Drug Administration permits stool transplantation after adequate donor screening and a discussion about risks and benefits. There may be a need for insurance prior authorization before stool transplantation. Contact your insurance company.

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Article Information

Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Khanna reports serving as a consultant to Rebiotix Inc, Summit Pharmaceuticals, and Assembly Biosciences for C difficile–related studies. No other disclosures were reported.

Source: Lee CH, Steiner T, Petrof EO, et al. Frozen vs fresh fecal microbiota transplantation and clinical resolution of diarrhea in patients with recurrent Clostridium difficile infection: a randomized clinical trial. JAMA. 2016;315(2):142-149.

Topic: Infectious Diseases