Frequently Asked Questions About Fecal Transplants
Key takeaways:
A fecal transplant is exactly what it sounds like. It’s a treatment that uses stool from a healthy person to treat someone with intestinal bacteria that’s off balance.
Evidence shows that a fecal transplant cures recurrent intestinal infections with Clostridioides difficile infections better than antibiotics. Researchers are also studying fecal transplants as a possible treatment for other conditions, like weight loss, multiple sclerosis, and autism.
Fecal transplant is generally considered safe with minor side effects such as gas, cramping, and diarrhea. With improved donor screening, risks like infection are rare.
The idea of a fecal transplant may sound like an off-putting idea to some people. But it’s actually gaining traction as an effective treatment for several medical conditions. It can cure recurrent Clostridioides difficile infections, a gastrointestinal infection that is increasingly common and can be particularly hard to treat. And researchers are looking into how fecal transplants can help a wide variety of other conditions. We’ll review how a fecal transplant works, the conditions it can potentially treat, and its safety.
What is a fecal transplant?
To understand a fecal transplant (also called a “fecal microbiota transplantation”), it’s helpful to think about how a normal gut works. In a healthy intestine, there are hundreds of helpful bacteria, also known as the “gut microbiome.” These friendly bacteria help with digestion, and they also play an important role in our immune system. They also keep harmful bacteria in check.
Every person has a different combination of gut flora, which is mainly determined by where they live and what they eat. Genetics and underlying medical conditions can also contribute to that unique mix of bacteria.
Save every month on GLP-1 meds with GoodRx
Save an average of $235 on FDA-approved GLP-1s like Ozempic and Zepbound.
A number of things can lead to an imbalance in your gut microbiome. A course of antibiotics, an illness, or even a change in diet can affect your gut flora. An imbalance can sometimes cause an overgrowth of different species of bacteria. Such a change can cause anything from mild digestive symptoms and to a life-threatening infection.
This is where a fecal transplant can help. It’s a way to transfer stool from a healthy person into the gut of someone who doesn’t have a balanced gut flora.
How does a fecal transplant work?
You may be wondering about the specific steps in a fecal transplant. Here is a general overview of the process.
The first step is to get donor stool. When scientists first developed the treatment, people often had to find someone with healthy gut bacteria who would be willing to help. But now there are stool banks that make it easier for people and providers to choose the right donor.
Potential donors undergo an extensive screening process to make sure they (and their stool) are healthy. This starts with questionnaires that gather information — from medical history to travel history. Then the donor provides blood and stool samples for lab testing to make sure their stool is safe for transplant.
The next step is to blend and mix the donor stool with salt water. Then a filter strains out the solid particles. The remaining liquid contains a healthy mixture of gut bacteria for use in the actual fecal transplant.
Read more like this
Explore these related articles, suggested for readers like you.
There are several different ways to get a fecal transplant:
Nasal intestinal tube: A provider inserts a tube through your nose that goes down into your gut. Then they inject the donor stool directly into your intestine.
Colonoscopy: A provider inserts a camera through your anus to your colon. The advantage of this method is that your provider can see your colon while they administer the transplant to the entire colon.
Enema: A provider uses a tube to insert the transplant just inside the anus. Many people are familiar with enemas as a way to give laxative medications. The disadvantage is that only the last part of the colon receives the healthy gut flora.
Capsule: The bacteria is in the form of a pill form that you can swallow.
Despite studies comparing these delivery methods, there’s no one best way to do a fecal transplant. Many different factors can go into choosing the best method for each person. Factors include safety considerations, whether or not your provider needs to visualize your colon, as well as cost and comfort.
What does a fecal transplant treat?
There’s a wide range of conditions that a fecal transplant can potentially treat. But the FDA currently considers it an investigational drug.
Researchers first studied fecal transplant in the treatment of recurrent C. diff — and this remains its most common application. C. diff is a bacteria in the intestine, but sometimes overgrowth can cause severe diarrhea. Antibiotics can often treat this infection. But recurrent infections can happen, even with antibiotics. People who have had at least two or three infections are candidates for fecal transplant. Some studies show it to be more effective than antibiotics.
Recurrent C. diff infections are the only condition for which you can use a fecal transplant without special documentation. For all other uses, your medical team has to apply for FDA approval to use it as an investigational drug. Here are the conditions that researchers are studying:
Inflammatory bowel disease: A change in the intestinal bacteria may contribute to ulcerative colitis and Crohn’s disease. Studies show symptom remission in some ulcerative colitis patients. There’s an ongoing study for Crohn’s disease.
Obesity and metabolic syndrome: Changes in gut flora have been linked to obesity. Some studies show fecal transplant may also help insulin work better, but the effect tapered off after 4 months and didn’t bring significant changes in weight.
Irritable bowel syndrome: A number of studies have looked at fecal transplant for this condition, but the results are still inconclusive.
Multiple sclerosis: Several studies have demonstrated that improving the gut microbiota can decrease risk of flares.
Autism: Recent studies show that fecal transplant can improve symptoms in autism spectrum disorders over the long term.
Hepatic encephalopathy: This occurs in liver disease and cirrhosis when ammonia levels build up in the blood and cause confusion. Studies using fecal transplant to treat this condition show promise. The idea is that the healthy microbiota can help remove the harmful ammonia.
Is a fecal transplant safe?
Fecal transplant is generally considered safe. Some of the the common side effects include:
Diarrhea
Cramps
Nausea
Bloating
Gas
Constipation
Rigorous screening of donor stool has improved safety. Stool banks have been able to decrease transmission of infection as well as multidrug resistant organisms (MDROs). MDROs, or “superbugs,” are germs that have developed ways to survive antibiotic treatment. Regulation of stool banks adds an additional layer of safety and peace of mind for those considering this treatment.
The bottom line
Studies show that fecal transplant can successfully treat recurrent C. diff infections. Despite that success, it isn’t a widely used therapy yet. Ongoing research will likely identify other conditions that may benefit from fecal transplant. The creation of stool banks and improved screening processes have made it more accessible and safe. With the growing number of potential applications and improvements in regulation, fecal transplantation is likely to become a more mainstream treatment in the future.
Why trust our experts?
References
Allegretti, J. R., et al. (2019). The evolution of the use of faecal microbiota transplantation and emerging therapeutic indications. Lancet (London, England).
Centers for Disease Control and Prevention. (2021). What is C. diff?
Chen, J., et al. (2021). Stool banking for fecal microbiota transplantation: Methods and operations at a large stool bank. Frontiers in Cellular and Infection Microbiology.
Drew, L. (2020). Highlights from studies on the gut microbiome. Nature.
Kang, D. W., et al. (2019). Long-term benefit of microbiota transfer therapy on autism symptoms and gut microbiota. Scientific Reports.
Schepici, G., et al. (2019). The gut microbiota in multiple sclerosis: An overview of clinical trials. Cell Transplantation.
U.S. Food and Drug Administration. (2013). Guidance for industry: Enforcement policy regarding investigational new drug requirements for use of fecal microbiota for transplantation to treat clostridium difficile infection not responsive to standard therapies.
Wang, J. W., et al. (2019). Fecal microbiota transplantation: Review and update. Journal of the Formosan Medical Association = Taiwan Yi Zhi.
