Fecal Microbiota Transplant (FMT)
- What is FMT?
FMT refers to the transferring of processed stool collected from a healthy donor into the intestinal tract of a recipient patient. The purpose of the procedure is to replace the microbiota of a recipient patient with that of a heathy donor.
- What is the microbiota?
'Microbiota' is the term used to describe the complex community of microorganisms (microbes) that live symbiotically with a host. In this case, within the intestinal tract of the patient.
- Are all microbes harmful?
No. In fact, most microbes serve important roles in keeping us healthy. Many microbes perform tasks that our bodies cannot including digestion of complex carbohydrates, vitamin synthesis, metabolism of hormones, and helping our immune system keep harmful microbiota (pathogens) from making us sick.
- What is Bacteriotherapy?
What is bacteriotherapy? Bacteriotherapy is the term used for the intentional use of bacteria or their products to treat an illness. Probiotics and FMT are examples of bacteriotherapy.
- What are probiotics?
What are probiotics? Probiotics are microbes that have health benefits for the host. Most commercially available probiotics are derived from food sources such as cultured or fermented foods and are ingested in capsule or powder form.
- What is the difference between probiotics and FMT?
Probiotic products include one or a few selected species of beneficial organisms and are usually ingested by mouth. FMT includes the entire stool population of organisms (after screening for the known dangerous or harmful ones) and can be ingested in capsules, administered rectally via enema or transplanted during endoscopy.
- Who may be a candidate for FMT?
Currently, FMT is used to treat patients with recurrent C. difficile infection (CDI). As a consequence of antibiotic use, the normal microbiome can be disrupted allowing C. diff to opportunistically colonize the intestinal tract.
- How does FMT cure recurrent C. difficile infection?
FMT works by restoring the natural balance and diversity of the intestinal microbiota via donor stool. The donated stool contains protective microbiota that suppresses C. difficile, and rebuilds a stable microbial environment in the large intestine.
- Is FMT FDA-approved?
As of 2021, the Food and Drug Administration (FDA) considers FMT appropriate in select patients and only for recurrent C. diff. It is considered an experimental treatment for all other indications. Use of FMT for any other illness or indication should only be done under the direction of a research program.
- What are the risks of FMT?
Overall FMT is considered to be safe with mild adverse events (diarrhea and abdominal discomfort resolving without medical intervention) occurring in up to 28% of patients. Serious complications including transmission of pathogenic organisms, infection, and complications leading to death are rare.
- How is FMT delivered to the patient?
FMT can be performed by different methods. The prepared specimen can be delivered using a feeding tube passed through the nose into the stomach, or by using an endoscope through the mouth that is advanced into the small intestine. More often, it is delivered using a colonoscope, a tube introduced into the large intestine via the rectum, or via a rectal enema. Capsules of FMT for oral delivery are being currently evaluated and may be available soon.
- Where does the FMT material come from and how much does it cost?
Historically, most fecal specimens were obtained individually from screened healthy relatives or friends of the patient who needed the transplant. This remains an option, but can cost >$500 to complete the appropriate donor screening process and may not be covered by insurance companies. More recently, frozen specimens obtained from pre-screened healthy donors have become available from national stool banks. The cost for FMT usually ranges between $500-1500 depending on route of delivery, insurance coverage, and donor source.
- How can I find a doctor who performs FMT?
Check with your primary care provider, local medical center or gastroenterologist who can refer you to a local physician performing FMT. There are also many private, online websites that maintain registries of providers.
Author(s) and Publication Date(s)
Ronald Hsu, MD, FACG, University of California, Davis School of Medicine and Neil Stollman MD, FACG, University of California, San Francisco School of Medicine – Published July 2016