What is FMT?
Your body has a lot of necessary (good) bacteria in its gastrointestinal (GI) tract. Fecal Microbiota Transplant (FMT) involves taking stool from a healthy person and transferring it into a person suffering from a disease caused by reduced amounts of the necessary (good) bacteria. Fecal transplant is most commonly used as a treatment for a disease caused by overgrowth of a (bad) bacteria called Clostridium difficile or “C diff” when standard treatment therapies have failed.
How does FMT work?
Our GI tract contains thousands of different bacteria and other microorganisms which are essential to maintaining health. Antibiotics can disrupt these bacteria and allow disease-causing bacteria such as C diff to flourish. Fecal transplant involves transferring the necessary (good) microorganisms from a healthy donor into a patient with C diff infection. These bacteria then begin to grow in the patient’s colon and prevent C difficile from overgrowing again.
How is FMT performed?
Your doctor introduces a solution of donor stool and saline into your GI tract during a colonoscopy. Other methods which have been successfully used elsewhere (and which may be considered in select patient cases) include fecal enemas and infusion through a nasogastric (nasal) tube into the upper part of your GI tract.
What is the success rate?
Controlled clinical research studies looking at fecal transplant success rates have yet to be completed, so we do not have that type of data. However, there are over 200 case reports in the world’s medical literature to date, reporting an overall success rate of 92%- 95%. Links to these publications are available for physicians or patients to review upon request. Your doctor has treated dozens of patients with relapsing C difficile over the past 3 years and has had a similar success rate in her experience.
Is FMT safe?
To date, there has not been any documented cases of infection transmitted through fecal transplant. That being said, feces are a “bodily fluid” and proper donor screening and testing is essential. Donors complete a screening questionnaire similar to that which is done at blood banks and for organ or tissue transplants. Prospective donors with risk factors for HIV and viral hepatitis are excluded from donating. Persons with significant gastrointestinal or autoimmune disease or a history of malignancy are not acceptable donors. Donors who meet the criteria undergo blood work testing for HIV, Hepatitis A, B and C, and syphilis. They are also asked to submit stool to be tested for bad bacteria (such as salmonella), parasites and C difficile. Patients are asked to sign a consent form acknowledging the risks of undergoing a colonoscopy as well as theoretical risks related to the fecal transplant itself (infection, allergic or immune reaction, other disease transmission).
Am I a candidate for FMT?
Your doctor performs fecal transplant for patients who are suffering from recurring C difficile. In general, her patients have had at least 3 recurrences and have failed at least one tapering course of the antibiotic Vancomycin. Patients who have experienced 2 more severe episodes of C difficile infection (admitted to an intensive care unit) are also possible candidates. At this time Your doctor is not performing fecal transplant on patients for irritable bowel syndrome (IBS), inflammatory bowel disease (Ulcerative Colitis or Crohn’s) or other conditions outside of C difficile.
Who should be my donor?
The best donor is somebody in good health who has not taken any antibiotics for at least 90 days. Most patients chose an immediate family member, although the donor does not necessarily have to be related to the recipient.
What kind of screening tests are needed? Are these tests covered by the donor’s health insurance?
Feces are a “bodily fluid” and proper donor screening and testing is essential. Donors complete a screening questionnaire similar to that which is done at blood banks and for organ or tissue transplants. Prospective donors with risk factors for HIV and viral hepatitis are excluded from donating. Persons with significant gastrointestinal or autoimmune disease or a history of malignancy are not acceptable donors. Donors who meet donor criteria undergo blood work testing for HIV, Hepatitis A, B and C, and syphilis. They are also asked to submit stool to be tested for parasites and C difficile.
Donors are cautioned that their health insurance may not cover the costs of these screening tests which may amount to several hundred dollars.
How much does FMT cost? Is it covered by my health insurance?
There is no “fee” for the fecal transplant itself. The procedure is performed during a colonoscopy or sigmoidoscopy which is usually indicated for patients suffering from chronic diarrhea and reccuring C difficile infection. Most insurance plans cover the costs of the patient’s laboratory testing and the colonoscopy. However, to be sure, patients are urged to check with their insurance company to get detailed information about co-pays, deductables, and requirements for referrals (especially regarding out-of-network or out-of-state providers).
I can’t find a doctor in my area who performs FMT. My doctor may be willing to perform it, but isn’t sure how. Who can help?
Your doctor is happy to speak with other physicians interested in performing the procedure and share her protocol. Map of all providers currently performing or planning to perform FMT is available here.