It might sound like a science fiction horror story, but transplanting poop from “super donors” to IBS patients is a reality. A fecal microbiota transplant (FMT) is a procedure that is now offered at facilities like the Cleveland Clinic, Johns Hopkins, and the Mayo Clinic.
Despite the procedure not yet approved by the Food and Drug Administration, several insurance companies now also reimburse the full (or a portion) of the amount, making it more accessible to the general population.
So why are more gastroenterologists accepting the idea of fecal transplants? Let’s start with the problem.
Growing number of C. difficile infections
Clostridioides difficile (C. difficile) is a bacteria that causes severe diarrhea and colitis (an inflammation of the colon). It’s estimated to cause almost half a million infections in the U.S. each year. In most cases, C. difficile infections occurs when the delicate bacterial balance in the gut is upended. Usually, it’s when people have been on antibiotics too long. Other risk factors includes age (65 or older); a recent stay at a hospital or nursing home; a weak immune system; or those taking immunosuppressive drugs.
What does this have to do with IBS? People with IBS typically don’t have a balanced amount of bacteria in their gut. Researchers believe that this lack of bacterial diversity, or dysbiosis, is one of the factors that contributes to the condition.
The symptoms — whether it’s a C. difficile infection or IBS — are usually:
Stomach tenderness or pain
Loss of appetite
Living through these symptoms can be exhausting and frustrating, leading to depression and poor quality of life. They’re unable to travel, eat certain foods, or spend time with family without worrying about what may happen.
Because the procedure is costly and has some risks (like any medical procedure) fecal transplants are often considered a last resort. It’s also not recommended for people who are immune suppressed or had bone marrow transplant or cirrhosis of the liver.
The three types of fecal transplants
Once the gastroenterologist agrees that an FMT is a viable option, there are three ways to deliver the healthy stool to the patient.
The healthy stool can be inserted into the colon via an enema or through a colonoscopy. The enema can be slightly uncomfortable, while most patients who choose a colonoscopy are given a light anesthetic.
Some facilities can insert the healthy donor feces through a tube that is inserted in through nose (nasoenteric) and fed down into the stomach to the small intestines.
A third way is a fecal-filled capsule that is designed to be swallowed. The coating doesn’t break down until it reaches the gut, delivering the healthy stool. As many as eight capsules will need to be ingested to receive the same amount of fecal matter distributed through the colonoscopy, enema, or nasal passage.
Do fecal transplants work?
A growing number of studies have shown that the procedure is effective and often resolves the symptoms within a few hours to a few days. In a double blind, large study published recently in the Gut Journal, researchers conclude that FMT is an effective treatment for those with moderate to severe IBS — regardless of the subtype. About half of patients who went through the clinical trial had experienced significant improvements in abdominal symptoms, fatigue, and quality of life.
At one month following the transplant, the patients in the study had higher concentrations of bacteria that is necessary for a balanced microbiota, such as Lactobacillus, Bifidobacterium and Bacteroides.
While more gastroenterologists are becoming comfortable with the idea of FMT for treating IBS or recurrent C. difficile, it’s important to emphasize that not everyone knows how to do the procedure safely. Before signing on to an FMT therapy, make sure that the medical center and physician has had enough experience and history with it.
Traits of a Super Donor
Super donors are individuals who are not only healthy and eat a healthy diet. The clinical trial study cited in this article used stool from a super donor who had the following traits and behavior:
Does not participate in risky social or sexual behavior
Does not abuse drugs
Has no metabolic or neurological disorders (e.g., diabetes, depression)
Not obese (normal to low body mass index)
Born via vaginal delivery
Breastfed as an infant
Had limited exposure to antibiotics before donation
Takes dietary supplements rich in proteins, vitamins, fiber and minerals
Not related to the patient
These factors lead to a rich bacterial environment in the donor’s gut, which indicate “normobyosis,” or a healthy balance of bacteria.