Growing evidence for the effectiveness of fecal microbiota transplants as a treatment for patients with recurrent bouts of Clostridium difficile-associated diarrhea was presented in studies this week at the American College of Gastroenterology’s 76th Annual Scientific meeting in Washington, D.C.
One study included 77 patients from five different states who previously had a colonoscopic FMT at least three months before for C. difficile infection, and found that FMT was successful in 70 out of 77 patients (91%). The patients on average were elderly and debilitated and had undergone multiple failed treatments, including antibiotic and probiotic therapies.
In six of the remaining seven patients, a single two-week course of vancomycin or a two-week vancomycin course plus one further FMT resulted in cure.
“While the concept of fecal transplantation may sound unpleasant to some, patient acceptance of this treatment is growing, especially when they have been suffering for months with recurrent C. difficile,” investigator Mark H. Mellow, MD, FACG, of INTEGRIS Baptist Medical Center in Oklahoma, said in a news release. “When we asked patients in our study about their choice of treatment if their infection recurred, 53% said fecal transplant would be their first choice for treatment.”
Results from a meta-analysis by researchers at the University of Toledo Medical Center provided further evidence of the effectiveness of FMT. Researchers reviewed the cases of 148 patients who had received fecal transplants for C. difficile infection. Follow-up ranged from 10 days to 62 months after the transplant, with an average follow-up of one year. Fecal transplant had an overall success rate of 85.4%, according to the researchers, who concluded that the procedure was a safe and effective treatment option.
With the growing success of fecal transplantation for C. difficile, researchers have started to explore the effectiveness of the procedure for other serious conditions such as inflammatory bowel disease. A study reported successful treatment of severe mixed IBD using recurrent fecal microbiota transplants in three patient cases.
In one case, a 19-year-old female — who had an 11-year history of severe IBD; presented with worsening symptoms, including bloody diarrhea and inflamed, ulcerated muscosa; and was considering a colectomy — experienced symptom improvement within several days after receiving FMT. She underwent FMT initially via colonoscopy in July 2009 and then by seven daily rectal FMT and 26 weekly FMTs. Follow-up colonoscopy revealed no gross inflammation or edema, with the patient remaining clinically well.
FMT may act as an antagonist to etiological infective agents and aid in reestablishing depleted bacterial species, thereby reversing IBD, according to the researchers, who are with the Centre for Digestive Diseases in Australia.