Fecal microbiota transplantation (FMT) is the administration of a solution of fecal matter from a donor into the intestinal tract of a recipient in order to directly change the recipient’s gut microbial composition and confer him/her a healthy benefit.
Nowadays, FMT has been used for successfully treatment of recurrent Clostridium difficile infection, a common cause of nosocomial diarrhea, whose incidence continues to grow up because of antibiotic therapies failure and infections recurrence. Fecal transplantation is an extremely more effective treatment than standard antibiotic therapy with a healing rate between 85%-95%.
The selection of stool donor for FMT consists of three steps: 1) an anamnestic evaluation by a dedicated questionnaire that investigates three main aspects: known history or risk factors for infectious diseases; history of gastrointestinal, metabolic, neurological diseases; use of drugs / substances that can alter intestinal microbiota; 2) a laboratory screening (serum and stool); 3) further clinical evaluation by questionnaire on the day of the donation.
The donor can be chosen either among the patient's family members or other healthy volunteers, as several studies reported that there is no difference between blood of related donors and external donors in terms of efficacy and safety.
We can be use fresh or frozen stools by dedicated protocols.
There are different routes of administration as colonoscopy, enema, naso-duodenal tube or gastroscopy, and capsules.
Before the infusion, the patient should be prepared with an intestinal lavage by polyethylene glycol and treated with vancomycin or fidaxomicin for at least 3 days before the procedure.
The patient must be followed during the post-procedural period to assess the onset of early adverse events. Furthermore, patient with CDI should be followed for at least 8 weeks after the procedure to assess the efficacy of the treatment and any short-term adverse events.
The most common short-term adverse events that can show up after fecal transplant are: diarrhea (in the first 24 hours of the procedure), abdominal pain, constipation, fever. Serious adverse events, such as bacteremia, intestinal perforation, death, are very rare.
The times and the best methods for the evaluation of long-term adverse events have not yet been certain identified.
The recent knowledge progress about our intestinal microbiota, its functions and role in the pathogenesis of several gastrointestinal and extraintestinal diseases, lays the foundation for the treatment of pathologies related to the alteration of the intestinal microbiota via FMT. For this reason, new fields of application are being studied in diseases associated with dysbiosis such as irritable bowel syndrome (IBS), chronic inflammatory bowel disease (IBD), metabolic disorders, multi-resistant germ infections.