Faecal Microbiota Transplant (FMT)

What is Faecal Microbiota Transplant?

Faecal Microbiota Transplant (FMT) is a procedure in which a healthy donor's faecal matter is transplanted into a patient's gut with an unhealthy microbiome. The procedure aims to restore a healthy balance of gut bacteria, which can alleviate symptoms and improve overall gut health.

What Conditions Does FMT Help?

FMT is an effective treatment option for several gut-related disorders. Here are some of the conditions that FMT may help with:

• Clostridioides difficile (C.diff) infection: FMT is more effective than antibiotics in treating recurrent or refractory C.diff infections.
• Inflammatory bowel disease (IBD): FMT has shown promise in treating ulcerative colitis and Crohn’s disease, although more research is needed to determine its role and long-term effectiveness.
• Irritable bowel syndrome (IBS): FMT may improve symptoms of IBS, including abdominal pain and bloating; however, further evidence is required to support this indication.

Why is Faecal Microbiota Transplant Required?

FMT is required to increase the presence of normal gut bacteria in the gastrointestinal tract in cases where aggressive antibiotic therapy has also killed the ‘good’ residual gut bacteria, thus leaving the individual more prone to certain infections.

Who is Faecal Microbiota Transplant Suitable For?

Faecal Microbiota Transplant is suitable for most individuals. 

It’s important to note that FMT is typically reserved for patients who have not found relief from traditional treatments or medications. Suppose you’re interested in exploring FMT as a potential treatment option. In that case, you must consult with a gastroenterologist to determine if you’re a suitable candidate and to discuss any questions or concerns you may have.

People suffering from a lung or heart condition or chronic disease such as diabetes need to be evaluated on a case-by-case basis.

What are the Benefits of Faecal Microbiota Transplant?

The benefits of FMT are numerous and include the following:

• High success rates: FMT has a success rate of up to 90% in treating C. diff infections.
• Long-lasting effects: FMT has been found to have long-lasting effects, with patients experiencing symptom improvements for up to 6 months post-procedure.
• Reduced need for medications: Patients who undergo FMT may be able to reduce their reliance on medications or even discontinue them altogether.
• Improved quality of life: FMT has been shown to enhance the quality of life for patients with gut-related disorders, reducing symptoms such as bloating, abdominal pain, and diarrhoea.

What are the Types of Faecal Microbiota Transplant?

There are three main types of FMT: colonoscopy, nasogastric/nasoduodenal tube, and oral capsules.

• Colonoscopy: In this procedure, faecal matter is transplanted into the colon via a colonoscope. This is the most common type of FMT.
• Nasogastric/nasoduodenal tube: This procedure involves inserting a tube through the nose, down the throat, and into the stomach or small intestine. The faecal matter is then transplanted through the tube.
• Oral capsules: This is the newest form of FMT, in which faecal matter is encapsulated into capsules and taken orally.

Preparation Before Faecal Microbiota Transplant

Before the procedure, the doctor may order some tests and prescribe antibiotics specific for treating C. difficile infections before performing a faecal transplant.

Before the procedure, the patient should be adequately counselled to ensure that the informed consent obtained is fully understood.

A complete history and physical examination are completed to determine eligibility for the procedure, which may include additional lab tests. The patient is also advised to stop smoking, drinking alcohol, and using anti-inflammatory medicines, including aspirin, before treatment to reduce the chances of bleeding.

The patient is also instructed to follow a strict liquid diet. An enema or laxative preparation will also be administered the night before the procedure to ensure a clean colon.

What Happens During a Faecal Microbiota Transplant?

The steps in Faecal Microbiota Transplant using colonoscopy include the following:

• Sedation: You will be sedated for the procedure to ensure you’re comfortable and relaxed.
• Colonoscope insertion: A colonoscope, which is a long, flexible tube with a camera on its end, will be inserted into your rectum and guided through your colon.
• Donor stool insertion: Once the colonoscope is in place, the donor stool will be inserted through the scope and into your colon.
• Procedure completion: The entire procedure typically takes around 30 minutes. Once the stool has been transplanted, the colonoscope will be removed, and you will be taken to a recovery area to rest.

What To Expect After Faecal Microbiota Transplant?

Immediately after the procedure, you will be transferred to the recovery room, where you will be monitored. Once stable, you will be discharged on the same day. You will also be prescribed pain medication and sometimes antibiotics to be used as instructed.

The procedure is considered a success if there is no recurrence of C. difficile colitis for eight weeks. Sometimes, the patient might require multiple faecal microbiota transplant (FMT) sessions.

Faecal Microbiota Transplant Recovery Plan

The recovery plan after an FMT is crucial to the procedure's success. Here are some critical steps to follow:

• Rest: Depending on the method used, you may need to rest briefly after the procedure. Your gastroenterologist will advise you on how long you should rest.
• Diet changes: Your gastroenterologist may recommend dietary changes to support the growth of healthy gut bacteria. This may include avoiding processed foods, increasing fibre intake, and reducing sugar and alcohol consumption.
• Probiotics: Your gastroenterologist may recommend probiotic supplements to promote the growth of healthy gut bacteria. Probiotic supplements containing strains such as Lactobacillus and Bifidobacterium are particularly effective.
• Follow-up appointments: Your gastroenterologist will schedule follow-up appointments to monitor your progress and ensure the transplant's success. These appointments may involve stool testing to confirm that the transplant was successful and that you are free of infectious diseases.
• Medication review: Your gastroenterologist will review your medications to ensure they won’t interfere with the FMT procedure. You may need to adjust your medications or stop taking them altogether.
• Exercise: Regular exercise has been found to improve gut health and promote the growth of healthy gut bacteria. Your gastroenterologist may recommend incorporating exercise into your recovery plan.
• Hydration: Drinking plenty of water is essential for maintaining gut health and preventing dehydration. Your gastroenterologist may recommend drinking more water in the weeks following the FMT procedure.
• Patience: The FMT procedure can take several weeks or even months to fully effect. Be patient and follow your recovery plan to ensure the best possible outcome.

Faecal Microbiota Transplant Success Rate

FMT has been found to have a high success rate in treating Clostridioides difficile (C.diff) infections, with success rates of up to 90%. FMT has shown promise in improving symptoms and quality of life for other gut-related disorders, such as inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS). Still, more research is needed to determine the long-term prognosis.

Faecal Microbiota Transplant Risks 

While FMT is generally considered safe, some risks are associated with the procedure. These include:

• Infection: There is a risk of infection if the donor's stool is contaminated with harmful bacteria or viruses.
• Gut discomfort: Patients may experience gut discomforts such as bloating, cramping, and diarrhoea in the days following the procedure.
• Allergic reaction: Rarely, patients may be allergic to the donor stool or other materials used during the procedure.

What if Faecal Microbiome Transplant is Delayed?

If your FMT procedure is delayed, following your gastroenterologist’s recommendations for managing your gut-related disorder is essential. This may include medication, dietary changes, and other treatments as appropriate.

What is the Cost of a Faecal Microbiome Transplant?

The cost of FMT can also vary depending on the method used. FMT using colonoscopy is generally more expensive than FMT using oral capsules. However, oral capsules are a newer and less widely available method, and the cost may be higher if the procedure is not covered by insurance.

Discussing the costs and coverage with your gastroenterologist and insurance provider is essential to explore FMT as a potential treatment option.