Fecal Microbiota Transplantation: An Update on Clinical Practice

TLDR

Fecal microbiota transplantation delivers healthy donor stool to restore gut microbiome balance and has proven effective for recurrent Clostridium difficile infection, prompting trials in other gastrointestinal and systemic disorders, though challenges such as defining a healthy microbiome, ensuring long‑term safety, monitoring recipients, maintaining quality control, and managing costs remain. The study aims to develop standardized stool‑preparation protocols, determine optimal administration routes, build extensive donor‑recipient databases, and confirm that oral FMT is as effective as colonoscopic delivery.

Abstract

Fecal microbiota transplantation (FMT) is an infusion in the colon, or the delivery through the upper gastrointestinal tract, of stool from a healthy donor to a recipient with a disease believed to be related to an unhealthy gut microbiome. FMT has been successfully used to treat recurrent Clostridium difficile infection (rCDI). The short-term success of FMT in rCDI has led to investigations of its application to other gastrointestinal disorders and extra-intestinal diseases with presumed gut dysbiosis. Despite the promising results of FMT in these conditions, several barriers remain, including determining the characteristics of a healthy microbiome, ensuring the safety of the recipient with respect to long-term outcomes, adequate monitoring of the recipient of fecal material, achieving high-quality control, and maintaining reasonable costs. For these reasons, establishing uniform protocols for stool preparation, finding the best modes of FMT administration, maintaining large databases of donors and recipients, and assuring that oral ingestion is equivalent to the more widely accepted colonoscopic infusion are issues that need to be addressed.