Fecal Transplant

Your digestion depends on a delicate balance of healthy bacteria in your intestines. Sometimes, the good bacteria in your body can be disrupted by sickness or medication, and you 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 your digestive system as well. When the healthy bacteria are gone, you are more susceptible to developing a C. difficile bacterial infection. It is also possible to develop C. difficile if you have been hospitalized and you are exposed to C. difficile spores.

C. difficile can be very difficult to eliminate. If you are diagnosed, your 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. Your doctor may suggest a second round of antibiotics, but sometimes the infection returns again.

What is a Fecal Transplant?

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

Finding a Donor

If your doctor recommends a fecal transplant, the first step is to find a donor. A donor can be someone that you know or it can be an anonymous donor.

The donor can be a family member, housemate or an intimate partner. The advantages of a donor who lives in the same household is that potential pathogens are often already present in both parties, so there would be less risk for you to contract an infectious agent from the transplant. A disadvantage of a donor who is related to you or lives with you is that the donor may be financially responsible for all testing required before transplant. A donor should check with his or her insurance company to determine financial obligation before agreeing to donate.

Fecal transplant can also be done using a frozen specimen from a laboratory bank. The advantage of using a frozen specimen is that the transplant can be done immediately because the frozen specimen has already been screened.

Whether you receive a stool specimen from someone you know or a stranger, there are specific criteria that donors must meet to be considered. They must have:

A healthy immune system.
No antibiotic exposure within the last six months.
No drug use.
No tattoos or body piercings in last six months.
No high-risk sexual behavior.
No history of incarceration.
No inflammatory bowel disease, colorectal cancer or other GI disorders.
No recent traveling to areas where disease is prevalent.
No anti-cancer drugs.

To ensure that all these criteria are met, the donor must undergo several screenings. Some of these screenings include:

Blood test to screen for Hepatitis A, B and C, HIV 1 and 2 and RPR (screening test for syphilis), HTLV 1 and 2 (viruses that can cause cancer).
Stool test to screen for parasites or ova (eggs), giardia (parasite that causes diarrheal illness) or C. difficile.

Preparing the Stool

The evening before the fecal transplant, the donor will take a laxative at bedtime. On the morning of the procedure, the donor will collect a fistful-sized amount of stool. The specimen must be diluted with saline to dissolve it and then filtered for particles. For transport, it must be stored in a clean, plastic container. It is important that the specimen be kept cool as it is transported to the endoscopy facility, and it is recommended that the stool be transplanted within six to eight hours.

What to Expect Before Procedure

Your gastroenterologist (GI) will go over all your current medication that you are taking and advise whether you should stop taking certain medication before the procedure. You will be asked to stop all antibiotics several days before the procedure. There are many different methods, but fecal transplant prep is similar to colonoscopy prep. Often, you will be asked to do a two-day liquid diet followed by a regimen of laxatives so there is no residual stool in your intestines. When you arrive at the endoscopy center, you will take two loperamide (Imodium or a similar medication) tablets to slow digestion.

What Happens During Procedure?

You will most likely be given a sedative through an IV to make you drowsy. Fecal transplant is performed by colonoscopy or nasoduodenal tube, a tube which is inserted through the nose and feeds down into the stomach and into the small intestine. Most commonly, though, the fecal transplant is done by colonoscopy. The colonoscope is advanced through the length of the colon, and as the scope is withdrawn the donor stool is delivered into your colon. Up to 500 cc of prepared stool will be placed into your right colon, and you should hold the stool for two to four hours or as long as possible.

What Happens After Procedure?

You will remain at the surgery center for a specified time after the procedure for monitoring. After the sedative wears off, your doctor will discuss the outcome of the procedure with you and make sure that you are comfortable. You may be groggy or tired from the medication. Your doctor will request that you rest for the remainder of the day, and even stay in bed for the rest of the day. Just as you would with a colonoscopy, you will need to have an adult with you to drive you home from the procedure.

It is important that the stool transplant remain in your intestines for as long as possible. Your doctor may give you some over-the-counter loperamide or an antidiarrheal medication, and also some specific dietary instructions. Depending on your doctor’s recommendations, you may be able to resume normal activities the following day. Before leaving the endoscopy center, you will schedule a follow-up visit.

What Are the Possible Outcomes?

Although fecal transplant is not officially approved by a regulatory body, its effectiveness is consistently above 90 percent. Therefore, fecal transplant is emerging as the preferred method to treat patients who have failed to eliminate C. difficile after many attempts with targeted antibiotics.